Fidelity and flexibility of care activities in child-centered youth care for children growing up in families experiencing complex and multiple problems

Researchers, practitioners, and policymakers in the field of child and family welfare have emphasized the need for child-centered services for children growing up in families experiencing complex and multiple problems (FECMP). However, the provision of evidence-based services for these children requires knowledge of the care activities of these services. The aim of this study was to investigate care activities and considerations related to the care provision of child-centered care for children growing up in FECMP. To study these care activities and considerations we investigated the care process of a program called Child and Youth Coaching. Hybrid coding was used to identify and compare care activities from multiple sources. In the first phase of analysis a coding scheme of care activities was derived from the program manual. Secondly, these care activities were identified from practice using daily care reports, intake forms, and interviews with coaches and the developers of the intervention. During this stage additional care activities were identified from practice. All care activities were compared across sources to assess whether care provision in practice adhered to the program manual (fidelity), and to investigate whether care provision varied across cases (flexibility). Furthermore, considerations that played a role in care provision were identified (considerations). The results showed treatment fidelity for most care activities. However, some treatment standards were only broadly defined in the program manual. Flexibility in treatment was mainly observed in the adaptation of problem assessment to the capabilities and interests of the child. Overall, Child and Youth Coaching promoted child participation by focusing on children’s perspectives in problem assessment, setting care goals, and determining care activities. However, several barriers to child participation were identified such as non-disclosure about the family situation, young age, and a lack of motivation. Although children experiencing these barriers to participation need additional attention in future intervention development and research, we conclude Child and Youth Coaching is a promising program in promoting the participation and wellbeing of children growing up in FECMP.