Effectiveness of care offered to multiproblem families

Multiproblem families (MPFs) provide a huge public health challenge because of socio-economic deprivation, psychosocial problems, parenting problems, domestic violence and rule-breaking behaviour. Therefore, the aim of the study is to evaluate the effectiveness of an organizational model to support MPFs in the Netherlands on the (social) participation, self-reliance and quality of life of MPFs. The model is based on the Flexible Assertive Community Treatment (FACT) and the outcomes of a literature study concerning effective elements of interventions for MPFs. We assess the effectiveness of this model comparing FACT with Care As Usual (CAU) among 200 MPFs in six municipalities . Primary outcomes are (social) participation and family functioning. Secondary outcomes are psychosocial problems, care use, health literacy, self-reliance, quality of life and the satisfaction with the organizational model. This study is conducted for a period of five years, applying questionnaires and qualitative interviews at four time points (T0, T1, T2, T3).

Multiproblem families (MPFs) provide a huge public health challenge because of socio-economic deprivation, psychosocial problems, parenting problems, domestic violence and rule-breaking behaviour. Therefore, there is a strong need for evidence-based approaches to successfully manage the difficulties of MPFs in various domains of life.



The aim of the study is to evaluate the effectiveness of an organizational model to support MPFs in the Netherlands. The model is based on the Flexible Assertive Community Treatment (FACT) and the outcomes of a literature study concerning effective elements of interventions for MPFs.

Measures will be assessed at inclusion (T0), after half a year (T1), after a year (T2) and after two years (T3) after the working method started within the municipalities. Questionnaires will be filled in at each time point by professionals, parents and children (>12 years).

Experimental condition (Flexible Assertive Community Treatment, FACT)

Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill people (SMI) in the community. In the Netherlands a Dutch version named FACT have been set up, Flexible Assertive Community Treatment. FACT is a rehabilitation-oriented clinical case management model, which is based on the ACT model but is more flexible and able to serve a broader range of clients with severe mental illness. The FACT team is a case management team with partly an individual approach and partly a team approach; the approach varies from client to client, depending on the client’s or family’s needs. For more stable long-term clients FACT provides coordinated multidisciplinary treatment and care by individual case management. Unstable clients or families at risk of relapse, neglect and readmission are provided with intensive assertive outreach care by the same team, working with a shared caseload for this subgroup.



Control condition (Care as Usual, CAU)

The control condition comprises the care as usual that is available for multiproblem families within the participating municipalities.