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This chapter describes the transition from an institution-based to a community-based approach to child welfare in Italy. Like many countries, Italy has seen a significant decline in residential placements from the early 1960s to the present. The legal and administrative developments that stimulated this shift are explored, as are some of the consequences, such as a far greater range of agencies involved, requiring strong interprofessional work. National guidelines for residential care are seen as a positive step, but implementation has been slow. Additional needs are for clearer definitions of the varieties of residential care offered and more research focused on needs and outcomes. The chapter concludes with the matrix used throughout the book, which provides information about the current policy context, key trends and initiatives, characteristics of children and youth served, preparation of residential care personnel, promising programmatic innovations, and present strengths and challenges.

Background and objectives The treatment of chronic illnesses requires health care professionals (HCPs) to master several nontechnical skills to meet patient care needs. This article aims to describe the rationale and the inductive process through which a self-assessment tool for the nontechnical skills of hemophilia teams was conceived, developed, and tested. Methods Starting from an explorative analysis of hemophilia HCP work experiences, the process followed 3 phases: an in-depth analysis of hemophilia HCP skills; the questionnaire development; and a pilot study. Results Using the voice of HCPs as a starting point, the tool proved to be able to identify precise cross-professional and intercultural challenges as well as related required and/or acquired skills in the hemophilia field. Conclusion The proposed tool may contribute to providing HCPs with strategic knowledge to successfully perform everyday practices, to improve the effectiveness of hemophilia teams and the care model adopted by their centers, and to implement intercultural research in this field. It may be used to propose ad hoc training courses targeted by challenge, in order to fill the major gaps reported by the teams, or targeted by medical specialty or country (and therefore health care system) specificity.

Background: Assessing the viewpoints of health care professionals concerning their work with chronic patients is a relatively new research topic, widely overlooked in the literature. However, understanding their subjective work experience is highly relevant for identifying problems and perceived resources, enhancing health service organisation, improving relationships or communication with patients, and maintaining well-being. Purpose and method: Qualitative data from the "Haemophilia Experience, Results and Opportunities" Initiative - a research program aimed at investigating the psychosocial aspects of hemophilia - were used to evaluate the experiences of 62 professionals from seven countries around the world. Semi-structured interviews were submitted to thematic analysis of elementary contexts with the aid of T-Lab software. Results: Five dominant themes emerged, identifying the main challenges that professionals have to deal with in their everyday work practice: caring for impaired adult patients; handling policies and stakeholders; providing counselling on diagnosis and reproductive choices; considering the role of family dynamics; coping with adolescent patients. Conclusion: The outcomes of the study provide an opportunity to develop the area of the non-technical skills in the core curriculum of those who work with chronic illnesses by focusing on cross-professional competences and by improving a comprehensive care model for hemophilia patients.

This paper investigates how the notion of comprehensive care (CC) in haemophilia is presented in institutional guidelines and specialized understandings. A literature review of the articles published in Haemophilia was carried out. The main features which authors refer to when mentioning CC were outlined and compared with the principles, assumptions and recommendations set by the World Federation of Haemophilia in relation to this care model. The results show a fragmented scenario. First, very few articles are devoted/explicitly refer to CC. Second, only a few of them completely adhere to the notion of CC as proposed in institutional guidelines. In contrast, most articles stress a single feature, providing a partial view of the model. The focus is mainly on promoting physical health, which is however frequently associated with psychosocial health. Multidisciplinarity has great emphasis, too. Third, some key issues for CC emerge. They are implicitly present in institutional guidelines, but they become the very focus of some articles, which reflect on three challenges to be dealt with: care for all, transition care and systemic care. Such challenges offer the opportunity to clarify and expand the notion of haemophilia CC, and to propose future developments in research projects and interventions.

The main aim of the research is to study how youths affected by haemophilia, a congenital hemorrhagic chronic disease, make sense of their condition, with particular reference to the transition from early adolescence to early adulthood. We administered face-to-face semi-structured interviews to 20 Italian youths with haemophilia, aged 11–25 years, in on-demand treatment or prophylaxis therapy. A thematic analysis was performed with the help of software for textual data to figure out the main topics and the role of the two selected variables in the emergence of the themes (age and type of therapy). The results highlight how the experience of suffering from haemophilia is organized around five core themes (fragmented body, intimacy, family history, autonomy, dreams), that are more or less typical of some age group or kind of treatment. These results may be useful for designing appropriate and differentiated interventions for psychosocial support.

Diabetes mellitus type 1 is a chronic illness that has its onset in childhood or adolescence. It is determined by the insufficient production of insulin. The main therapies consist of replacement of the lacking insulin, diet, exercise, and glycemic control. If treatment is managed by parents in childhood, adherence seems to be a difficult issue during adolescence. In order to understand the subjective experience of the illness and treatment, the present study aims to investigate the patients’ subjective perspective by addressing a group of adolescents and young adults in pediatric care. A qualitative research design was adopted with semi-structured interviews, and later software thematic analysis was performed. Six core issues were deepened: family and health-care professional’s mediation support for self-management, adherence to treatments as a boring responsibility, disclosure problems in peer relationships, difficulty in becoming autonomous in a period of socioeconomic crisis, illness as concern for the future, and seeking a normal life in daily activities. The knowledge can be useful for designing more appropriate interventions that favor the active engagement of patients.

Adolescents are reluctant to seek help, especially those at psychopathological risk. School may represent the ideal setting to intercept teens in trouble by reducing some barriers to help-seeking behavior; despite this, some obstacles remain difficult to overcome. The present study, involving a large sample (N = 2235) of secondary school students, aims to investigate the effectiveness of a counseling service as part of a multifaceted school-based prevention program. The counseling service is assessed by comparing students who asked for help with their peers in terms of their psychosocial characteristics, risk profiles and perceptions of the strategies that professionals adopt in order to reduce the barriers to individual counseling. Our findings reveal the capacity of individual counseling to serve the most vulnerable adolescents, with the exception of students who might be at risk of school drop-out. The effectiveness of the program implementation theory and the strength of particular strategies used to reduce barriers are discussed.

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: "Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources". The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Dutch translation, comprises inter alia five basic principles of care that according to the Work Group on Therapeutic Residential Care should be guiding for residential youth care provided at any time.

none 32 si The International Work Group for Therapeutic Residential Care convened an International Summit on ‘Pathways to Evidence-Based Practice’ at Loughborough University (GBR), Centre for Child and Family Research on 27-29 April, 2016 with generous support from the Sir Halley Stewart Trust and in partnership with The European Scientific Association on Residential and Family Care for Children and Adolescents (NLD) (EUSARF), the International Association for Outcome-Based Evaluation and Research on Family and Children’s Services (ITA) (IAOBER) and the Association of Children’s Residential Centers (USA) and with the additional support of Action for Children (GBR) and the National Implementation Service (NIS) (GBR). Membership includes: Lisa Holmes (Chair), Director, Centre for Child and Family Research, Loughborough University (GBR); James K. Whittaker (Co-Chair), Charles O. Cressey Endowed Professor Emeritus, University of Washington, School of Social Work, Seattle (USA); Jorge Fernandez del Valle, Professor of Psychology and Director, Child and Family Research Group, University of Oviedo (ESP); Frank Ainsworth, Senior Principal Research Fellow (Adjunct), James Cook University, School of Social Work and Human Services, Townsville, Queensland (AUS); Tore Andreassen, Psychologist, The Norwegian Directorate for Children, Youth and Family Affairs (NOR); James P. Anglin, Professor, Faculty of the School of Child and Youth Care, University of Victoria (CAN); Christopher Bellonci, Board-Certified Child/Adolescent and Adult Psychiatrist; Associate Professor, Psychiatry Department, Tufts University School of Medicine, Boston, MA (USA); David Berridge, Professor of Child and Family Welfare, School for Policy Studies, University of Bristol (GBR); Amaia Bravo, Lecturer, Department of Psychology, University of Oviedo (ESP); Cinzia Canali, Senior Researcher, Fondazione Emanuela Zancan, Padova (ITA) and President, International Association of Outcome-Based Evaluation and Research in Family and Children’s Services (IAOBER); Mark Courtney, Professor, School of Social Service Administration, University of Chicago (USA); Laurah Currey, Chief Operating Officer, Pressley Ridge, Pittsburgh, PA (USA) and President, Association for Children’s Residential Centers, (USA); Daniel. L. Daly, Executive Vice President and Director of Youth Care, Father Flanagan’s Boys’ Home, Boys Town, NE (USA); Robbie Gilligan, Professor of Social Work and Social Policy, Trinity College Dublin IRE), Hans Grietens, Professor, Centre for Special Needs Education & Youth Care, University of Groningen (NLD) and President, European Scientific Association on Residential and Family Care for Children and Adolescents (EUSARF); Annemiek T. Harder, Assistant professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Martha J. Holden, Senior Extension Associate with the Bronfenbrenner Center for Translational Research and the Principal Investigator and Director of the Residential Child Care Project at Cornell University, Ithaca, NY (USA); Sigrid James, Professor, Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, CA (USA); Andrew Kendrick, Professor of Residential Child Care, School of Social Work and Social Policy at the University of Strathclyde (GBR) and Consultant at the Centre of Excellence for Looked After Children in Scotland (CELCIS) and the Centre for Youth and Criminal Justice (CYCJ) (UK); Erik J. Knorth, Professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Mette Lausten, Senior Researcher at SFI - The Danish National Centre for Social Research, Copenhagen (DNK), John S. Lyons, Senior Policy Fellow at Chapin Hall, University of Chicago, IL (USA); Eduardo Martin, Lecturer at the Department of Developmental and Educational Psychology, University of La Laguna, Tenerife (ESP); Samantha McDermid, Research Fellow, Centre for Child and Family Research, Loughborough University (GBR); Patricia McNamara, Senior Fellow (Honorary), Department of Social Work, University of Melbourne (AUS); Laura Palareti, Assistant Professor in Social Psychology, Department of Education Studies, University of Bologna (ITA); Susan Ramsey, Parent and Former Children’s Mental Health Advocate, The Walker School, Needham, MA (USA); Kari M. Sisson, Executive Director, Association of Children’s Residential Centers (USA); Richard W. Small, Walker Executive Director Emeritus, The Walker School, Needham, MA (USA); June Thoburn, Emeritus Professor of Social Work, University of East Anglia (GBR); Ronald Thompson, Senior Director, Boys Town National Research Institute for Child and Family Studies, Boys Town, NE (USA); Anat Zeira, Professor, School of Social Work and Social Welfare, Hebrew University of Jerusalem, and Head of Research and Evaluation at the Haruv Institute (ISR). Our work group wishes to thank CFRC staffer Laura Dale at Loughborough for extraordinary efforts in producing this statement in record time and for her care and assistance with all phases of our Summit activity. Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat

To understand the normalization process in families with hemophiliac children, and to explore the impact of two different therapeutic regimes on it (on-demand therapy and prophylaxis), we conducted a two-phase study using semistructured interviews. In the course of the first phase, we interviewed 13 parents belonging to 10 families with hemophiliac children in on-demand therapy. In the second phase, 5 years later, we repeated the interviews with three families who began prophylaxis at different times. We analyzed the interviews using text analysis software. The results show very different representations of hemophilia and daily life. Normalization processes involve the overcoming of a divided conception of life, and encourage the integration of care practices within daily life. Moreover, in our article we suggest that although prophylaxis facilitates the recovery of a regular family routine, it alone cannot produce normalization.

Un tratto caratteristico delle malattie emorragiche congenite (di cui la piů diffusa č l'emofilia) č l'imprevedibilitŕ dell'evento emorragico, della sua durata e della sua severitŕ, da cui consegue una condizione di continua incertezza sulle modalitŕ e la tempestivitŕ necessarie per l'intervento. Il superamento di questa condizione č oggi possibile attraverso l'infusione del fattore di coagulazione mancante. Quest'ultima puň essere attuata tramite due modalitŕ: profilassi e terapia al bisogno. Questo studio ha come obiettivo la comprensione approfondita delle condizioni che favoriscono o che invece ostacolano l'adesione a forme diverse di trattamento terapeutico, in particolare profilassi e terapia al bisogno, in famiglie con bambini affetti da emofilia. Sono stati intervistati congiuntamente i genitori di 11 famiglie con figli emofilici in etŕ evolutiva, residenti a Bologna e provincia che aderivano a trattamenti differenziati (profilassi o terapia al bisogno). I risultati mostrano come le due diverse forme di terapia siano collegate a differenti rappresentazioni della malattia e a diverse modalitŕ di funzionamento familiare. La profilassi si conferma la terapia che maggiormente si accompagna ad uno stile di vita normalizzato sia per il bambino che per l'intera famiglia.

Some conceptual and methodological issues in the evaluation of residential care for children and adolescents are discussed comparing different ways of understanding an ecological approach to outcome evaluation. An original Ecological Model for the Evaluation of Residential Care representing an example of a theory-driven approach based on developmental psychopathology and Bronfenbrenner's Ecological Theory is illustrated. This model provides a framework for analyzing and explaining the relationships between the intervention ecosystem and children's outcomes.

The contribution is a commentary to the method presented by L. Holmes "Estimating Unit Costs for Therapeutic Residential Care". In particular, on the basis of interviews with different stakeholders, the method proposed by Holmes is discussed with regards to its Feasibility and Utility within the Italian child protection system

Purpose The purpose of this paper is to describe the relationship between migratory status, the use of legal and illegal psychoactive substances and psychological disorders perceived in a sample of minors. Design/methodology/approach A transversal multicentre study was carried out with interviews with young people aged 13-16 years recruited from middle and high schools in Italy. Findings The results show the implementation of a process of normalization in terms of the presence of legal and illegal psychoactive substances in the living contexts of the minors, of their widespread early use and of a substantial indifferentiation in the reasons for use (e.g. pleasure, curiosity, fun). Youths born in Italy with at least one non-native parent are noteworthy for an elevated prevalence of perceived psychological disorders and for particular lifestyles linked to the use of marijuana, alcohol abuse and the intensive consumption of tobacco. Second-generation minors show symptoms of psychological malaise, anxiety and depression before which the use of substances appears to realize a particular form of self-cure. Research limitations/implications This study presents some objective limits that indicate prudence in generalizing the results: only those who obtained consent from their parents were interviewed and the information communicated in the interviews could have been influenced by various factors, including the situation and the location. The authors used a standard definition of binge-drinking (Valencia-Martín et al., 2008). Actually, different criteria (i.e. number of drinks, time of consumption, etc.) and formulations of the question are used in different surveys, showing that there is as yet no consensus definition of binge-drinking. Nevertheless, the term has become somewhat confusing as it is often used as a synonym of drunkenness, making cross-cultural comparisons difficult (Beccaria et al., 2014). These are aspects that limit the generalizability of the results to the interviews alone and do not allow for prevalence estimates. Nevertheless, the results offer useful indications for future prevention projects specifically oriented to early adolescence. Practical implications The results of the study, on the one hand, document the growing use of legal and illegal proactive substances among minors and the relative cultural trend in this particular age band, testified to by the high number of those who have been present in situations of consumption to whom the substances were offered; on the other, they evidence a subpopulation of youths born in Italy with at least one non-native parent (i.e. second generation of immigrants). These youths stand out for an elevated prevalence of perceived psychological disorders and for their particular lifestyles connected to the use of marijuana, alcohol abuse and the intensive consumption of alcohol. This is also the group with the highest percentage of mothers alone in the family. Social implications A group of adolescents living in a monoparental family, that is, with the mother alone emerges, and as the literature has shown, family structure and poverty are linked (Landale et al., 2011; Svensson and Hagquist, 2009). In fact, such mothers, even those with a high level of education, are mostly unemployed. Adolescents with a single parent often not only face resource deficits but also other risk factors, such as high family stress, inadequate supervision, multiple family transitions and frequent residential moves. Specifically, these second-generation adolescents are female and they manifest sensation-seeking behaviours, but without drug abuse. Originality/value The results of the study show new and little-known aspects of the multicultural Italian society that is changing profoundly that should be explored in more detail by targeted research that also focussed on structural factors relatable to specific social positions. In this framework, a particular subgroup, i.e. the second-generation minors, shows symptoms of psychic malaise, anxiety and depression in terms of which substance use seems to realize a form of self-cure.

The study illuminates the subjective experience of haemophilia in people who took part in the Haemophilia Experience, Results and Opportunities (HERO) initiative, a quali-quantitative research program aimed at exploring psychosocial issues concerning this illness around the world. Applying a bottom-up analytic process with the help of software for textual data, we investigated 19 interviews in order to describe the core themes and the latent factors of speech, to explore the role of different variables in shaping the participants’ illness experiences. The five themes detected are feeling different from others, body pain, acquisition of knowledge and resources, family history, and integration of care practices in everyday life. We illustrate how nationality, age, family situation, the use of prophylaxis or on-demand treatment, and the presence of human immunodeficiency virus or hepatitis C virus affect the experience of our participants in different ways. Findings are used to bring insights on research, clinical practice, and psychosocial support.Key words: Haemophilia, patient perspective, thematic analysis, psychosocial, cross-cultural(Published: 16 November 2015)Citation: Int J Qualitative Stud Health Well-being 2015, 10: 28915 - http://dx.doi.org/10.3402/qhw.v10.28915

Il contributo documenta un’esperienza di sostegno psicologico rivolta a famiglie con bambini affetti da malattia emorragica congenita (di cui la più diffusa è l’emofilia). Precedenti ricerche hanno evidenziato che la diagnosi di emofilia comporta per i genitori difficoltà psicologiche nella elaborazione della nuova situazione e problemi organizzativi relativi alla gestione quotidiana delle cure. Con il contributo dell’Associazione Emofilici di Bologna, sono stati realizzati incontri di gruppo finalizzati a far incontrare persone che stavano attraversando le stesse difficoltà, facendole riflettere e discutere sui bisogni che coinvolgono i bambini e le loro famiglie. Tale intervento ha permesso sia il confronto e la riflessione dei partecipanti, sia di verificare, attraverso un software di analisi dei testi, le tematiche emerse negli incontri di gruppo, ampliando le conoscenze sui processi psicosociali che coinvolgono le famiglie stesse. Il presente contributo descrive le scelte metodologiche compiute nella gestione dell’intervento e i risultati di ricerca prodotti.

In Italy, the evaluation of residential care is particularly important in view of: (1) the process of deinstitutionalization; (2) the power of the public authorities to devolve the running of services, including residential communities, to private partners. The literature has stressed the importance of involving multiple stakeholders in the design and implementation of evaluative research. This article summarizes a research plan for the evaluation of child and adolescent residential communities based on the theoretical framework of developmental psychopathology and Bronfenbrenner's ecological model of human development. A study is presented on the perception that adolescents in care have of the community's relational climate-analyzed by way of everyday routines and communications with adults-and of the effects of the intervention. The results corroborate the hypothesis that the relational climate in a community is a good predictor of the efficacy of residential care.

In veel ontwikkelde landen wordt in toenemende mate kritiek geleverd op residentiële interventies bij kinderen en jongeren. Tegen de achtergrond hiervan vond in het voorjaar 2016 in Engeland een internationale conferentie plaats van experts uit 13 landen op het gebied van therapeutische residentiële zorg (TRZ). De volgende werkdefinitie van TRZ was leidend: "Therapeutische residentiële zorg omvat het geplande gebruik van een speciaal hiervoor ontwikkelde, multidimensionale leefomgeving, die tot doel heeft behandeling, onderwijs, socialisatie, ondersteuning en bescherming te bieden of te versterken voor kinderen en jongeren met welomschreven psychische en/of gedragsmatige problematiek; dit in samenwerking met hun gezin/familie en een breed scala aan formele en informele hulpbronnen in de samenleving". De bijeenkomst stond in het teken van kennisuitwisseling en het ontwikkelen van een internationale onderzoeksagenda. Tevens werden de contouren van een consensusverklaring over TRZ besproken. Deze verklaring, die hier integraal wordt weergegeven, omvat onder meer vijf basisprincipes van zorg, die in de visie van de Werkgroep TRZ altijd richtinggevend dienen te zijn voor goede residentiële jeugdhulp.

Since the attacks on the United States of America on September 11, 2001, a new interest in terrorism has been growing in psychology. Nevertheless, as underlined by many authors, no single agreement exists as to the actual definition of terrorism. In our opinion, from a psychosocial perspective, an ambiguous notion of terrorism may legitimate the ingroup/outgroup differentiation that affects intergroup relations. In this article, three studies were presented with the main aim to understand what people refer to when they talk about terrorism. In particular, the influence of ethnocentrism and importance of media information on the definition of terrorism will be analyzed. The results confirm the influence of both ethnocentrism and media. In that sense, the definition of terrorism may hide an implicit ideology on the notions of war and terrorism that enhances the ingroup/outgroup opposition.

In questo articolo presentiamo un'esperienza di applicazione di un modello di valutazione "theory driven" ad un ampio progetto di promozione della salute e prevenzione del disagio realizzato in diverse scuole secondarie nel Nord Italia. L'obiettivo del contributo è di discutere l'utilità teorica e metodologica di questo approccio nel rispondere a un'esigenza valutativa identificando quali componenti, secondo le teorie formali e implicite dei promotori del progetto, hanno un ruolo significativo nel garantire il successo del programma. L'approccio "theory driven" si è dimostrato funzionale a fare emergere alcuni elementi critici prima inespressi, che si sono rivelati coerenti con letteratura sui criteri di efficacia degli interventi di prevenzione e promozione della salute.