Journal of Social Intervention: Theory and Practice (Sep 2016)
De werkzame bestanddelen van de hulpverlening aan gezinnen met meervoudige problematiek
Abstract
The effective factors in support for families with multiple problems Numerous families in the Netherlands are struggling with multiple problems and the support provided for those families is undergoing many changes. In recent years, the government has transferred several of its social tasks to local councils, which were given responsibility for social support and youth welfare as of 2015. This devolution of responsibility is completely transforming the social domain, so it is crucial for parties in this field to focus increasingly on the development of active forms of support that are appropriate for first-line care for the target group.Families with multiple issues struggle with a combination of socio-economic and psycho-social problems. In addressing these problems, it is important that effective assistance is offered to these families. However, too few effect studies have been carried out into interventions as part of the assistance provided to this target group. For this reason, there is currently insufficient knowledge of which type of assistance is most effective for these families (Holwerda, Jansen & Reijneveld, 2014). There is also a lack of in-depth knowledge about the specific effective factors of the support offered to families with multiple issues. This qualitative study examines the effective factors of assistance for families with multiple problems as perceived by their social workers, in order to explicitly show the social workers' existing implicit knowledge about which elements of this support are effective. The research population consisted of a group of social workers employed by NIM. Social workers with expertise and experience in providing assistance to families with multiple problems were selected. The study yielded in-depth knowledge into the effective factors of assistance offered to families with multiple issues. The working relationship is considered by social workers to be one of the most important effective factors of assistance. They state that a good working relationship with the client plays a decisive role in a successful assistance process. The basic attitude of the social worker is essential for achieving a successful working relationship with the client. This basic attitude is characterized by involvement and transparency.The social workers state that the degree to which they take control of the client’s situation also plays a decisive role in the working relationship. According to them, the client is initially in control and this is most effective. But if the social worker assesses the living conditions of the client as seriously compromised, it can be more effective for the social worker to take control temporarily.In general, social workers devote considerable attention to promoting the motivation of parents in families with multiple issues. They consider this motivation to be one of the most important factors for successful assistance. The targeted use of interventions to promote this motivation is considered essential, with a distinction made between intrinsic and extrinsic motivation. In terms of taking control, if the social worker assesses that parents in families with multiple problems are sufficiently motivated, they can retain control of the situation. However, if there is little intrinsic motivation and living conditions are seriously compromised, it is more effective for the social worker to take control temporarily in order to (first and foremost) promote extrinsic motivation.Social workers state that targeted assistance to parents in families with multiple problems must include all facets of life. They do not believe that problems can be resolved through a fragmented approach. An integrated approach is needed to be able to provide effective support. According to the social workers, the financial problems should be assigned the highest priority. It is important that the financial situation is first stabilized as much as possible before dealing with problems in other areas of life. Social workers state that parents are often affected most by the financial problems. Other types of problems can only be effectively tackled once the financial situation is more stable or there is at least a prospect of a better financial future.The social workers in this study take an eclectic approach. There is no single methodology or approach that is considered to be the most effective. Consequently, none of the social workers questioned work according to the criteria of one specific method. They indicate that they have the knowledge and skills set of the various methods in their “toolbox” and use these in their work with clients. Finally, the social workers indicate that assistance should be clearly structured, with an action plan being formulated together with the client, including a primary goal and secondary goals that are assessed regularly during the assistance process. The insights yielded by this study contribute to our knowledge of the most effective approach to families with multiple problems. The results are currently being translated by NIM into a practical approach that fulfils the basic principles of the transformation in youth care. SAMENVATTING De werkzame bestanddelen van de hulpverlening aan gezinnen met meervoudige problematiek Er zijn in Nederland veel gezinnen die kampen met meervoudige problematiek. De hulpverlening die geboden wordt aan deze gezinnen is aan grote veranderingen onderhevig. In de afgelopen jaren zijn er overheidstaken in het sociale domein naar de gemeenten overgeheveld. Met ingang van 2015 zijn gemeenten verantwoordelijk voor de maatschappelijke ondersteuning en de jeugdzorg. Deze decentralisaties zorgen voor een ware transformatie in het sociale domein. Het is nu dan ook van cruciaal belang dat er vanuit het sociale domein meer aandacht besteed wordt aan het ontwikkelen van voor de eerstelijns zorg geschikte werkzame hulpvormen voor deze doelgroep. In deze kwalitatieve studie zijn de werkzame bestanddelen van de hulpverlening aan gezinnen met meervoudige problematiek volgens de hulpverleners onderzocht, om zodoende hun aanwezige impliciete kennis over wat werkzaam is in deze hulpverlening te expliciteren. Er zijn semigestructureerde interviews afgenomen onder 12 hulpverleners werkzaam bij NIM Maatschappelijk Werk. Dit onderzoek heeft geresulteerd in inzicht in de werkzame bestanddelen. De belangrijkste resultaten zijn: 1) Cruciaal is het zorgdragen voor een goede werkrelatie, door middel van een betrokken en transparante basishouding; 2) nadrukkelijke aandacht voor het bevorderen van de motivatie wordt ook als een werkzaam bestanddeel gezien, waarbij er onderscheid gemaakt wordt tussen intrinsieke en extrinsieke motivatie; 3) een integrale aanpak met een eclectische werkwijze is nodig om effectieve hulpverlening te kunnen bieden; 4) hierbij dient de financiële problematiek de hoogste prioriteit te krijgen, volgens de hulpverleners; 5) verder dient de hulpverlening duidelijk gestructureerd te worden; 6) de regievoering heeft een grote invloed op de werkrelatie, waarbij de hulpverleners duidelijk maken dat de regie in eerste instantie bij de cliënt hoort, maar het in bepaalde situaties werkzamer is om de regie over te nemen. De resultaten worden momenteel door NIM vertaald in een praktische aanpak die voldoet aan de uitgangspunten van de transformatie in de jeugdzorg.
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