the community oriented programs environment scale

8/10/2019 The Community Oriented Programs Environment Scale

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ReportTITLE

The Community Oriented Programs Environment Scale

(COPES)- Use of the COPES in a research project on childwelfare institutions in Norway a description, literature re-

view and reflections

Barnevernets utviklingssenter

Post adress: NTNU Dragvoll

7491 Trondheim

Visit adress: Dragvoll All 38 B

Telephone: +47 73 55 08 40

Fax: +47 73 59 62 24

E-mail: [email protected]

Web.: www.samforsk.no

Foretaksnr. NO 986 243 836

AUTHOR

Kaat Lagae

INSTITUTION

Barnevernets utviklingssenter i Midt-Norge (BUS)

The Regional Child Protection Research Unit

REPORT NR. GRADING LEVEL FUNDING

22/2012 Open Barnevernets utviklingssenter i Midt-NorgeISBN NUMBER OF PAGES

978-82-91927-20-6 (trykt)

978-82-91927-21-3 web 43

PRICE SUPERVISED BY

Jim Lurie and Torill Tjelflaat

DATE QUALITY CONTROL BY

December 2012 Torill Tjelflaat, head of department BUS

SUMMARY

In this report, the Community Oriented Programs Environment Scale (COPES) was examined asan instrument for measuring social climate in child welfare institutions in Norway. A short de-

scription of the COPES and its background are presented, followed by a literature search focused

on one of the dimensions of the COPES Relationship. The literature shows that relationship is an

important concept which should not be overlooked in child welfare institutions. The report con-

cludes with a critical reflection on the use of COPES. Some younger children may require assis-

tance in reading and comprehending the questions. It is concluded that the COPES can be seen as

a valuable and important instrument for examining the determinants of social climate in communi-

ty programs, and for identifying strengths and weaknesses in the social climate of an institution.

Key words English Norwegian

Community Oriented Programs Evaluation

Scale

Social Climate Sosial milj

Child Welfare Institutions Barneverninstitusjoner

Relationship Dimension Relasjoner mellom barn og ansatt


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PREFACE

InthecontextofmystudyatthefacultyofEducationalStudiesattheUniversityof

Leuven,Iwas

given

the

opportunity

to

discover

the

process

of

research

in

Norway.

The last 16weeks, I haveworked at Barnevernets utviklingssenter iMidtNorge

(BUS);TheRegionalChildProtectionResearchUnit that isadepartmentat NTNU

SamfunnsforskningAS;NTNUSocialResearchAS.Formally,thisinternshipisaffiliat

edwithRegionsenterforbarnogungespsykiskehelse(RBUP),whichistheRegion

alCentreforChildandAdolescentMentalHealth.

IamverythankfultoallthepeopleatBUS,whogavemeaverywarmwelcomeat

theircentre

and

who

were

always

available

for

atalk

about

my

research

as

well

as

aboutmytrips inandaroundNorway.Aspecialwordofthanksgoestomytwosu

pervisors;JimLurieandTorillTjelflaat.Thankyoufortrustingmewithinthisbigpro

ject,givingprofessionalcontributionandsupport. Iexperiencedafabuloussenseof

hospitalityfromallofyou.

Duringmy internship, Iwasalsoable tovisit twochildwelfare institutionsand the

regionalcentreforchildandadolescentmentalhealth(RBUP).Iwanttothankallthe

peoplewhowelcomedmeduringthesetripsandwhodidntmindspeakingEnglish

throughouttheday.Iwasprovidedalotofusefulandinterestinginformationabout

theorganisationofchildwelfareinNorway.

Thereafter,IamgratefultoprofessorHansGrietensfromtheUniversityofGroningen

whomadethisinternshippossibleandgavemealotofprofessionaladvicealongthe

way.

Duetothekindsupportofallofyou,IexperiencedthisadventureinNorwayasalife

changingevent

in

which

Iwas

taught

alot

of

self

knowledge,

independency

and

re

searchqualities.

Trondheim,Norway,December2012

KaatLagae


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TABLEOFCONTENTS

PREFACE................................................................................................................ iii

1 INTRODUCTION

................................................................................................

1

2 ABOUTTHECOPES........................................................................................... 3

2.1 WhatistheCOPES?......................................................................................................... 3

2.2 MeasuringsocialclimatewiththeCOPES........................................................................ 6

2.3 HowistheCOPESusedintheResearchProgram?........................................................... 8

3 FOCUSONRELATIONSHIPDIMENSION........................................................... 11

3.1 Involvement................................................................................................................. 12

3.2 Support......................................................................................................................... 14

3.3 Spontaneity

..................................................................................................................

16

4 THEUSEOFTHECOPESWITHCHILDRENANDYOUNG PEOPLE....................... 19

4.1 StudiesusingtheCOPESwithadolescents..................................................................... 19

4.2 CriticalreflectionofusingtheCOPESwithchildren....................................................... 28

5 DISCUSSIONANDSUMMARY......................................................................... 33

REFERENCES.......................................................................................................... 37

Listoftables.......................................................................................................... 41

Listoffigures........................................................................................................ 43


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1 INTRODUCTION

TheprojectMentalhealthinchildrenandadolescentsinchildwelfareinstitutionsis

an ongoing, large scale research, conducted by two research centres, located in

Trondheim.ThesearetheRegionalChildProtectionResearchUnitforCentralNorway,

and theRegionalCentre forChildandAdolescentMentalHealth,MidNorway.The

project isadministeredby a leader group consistingof representatives from these

twocentres,andmembersfromtheDepartmentofLaboratoryMedicine,Childrens

andWomensHealthand theCentre forDevelopmentalPsychopathology.Thepro

jectaimstoincreaseknowledgeaboutchildreninwelfareinstitutionsinNorwayand

theirmental

health.

Ithasthreemainobjectives,being1)togainknowledgeaboutchildrenandadoles

centsintheagegroup1223yearswholiveinchildwelfareinstitutions,focussingon

mentalillnessandpsychosocialadjustment;2)toidentifyinstitutionalcircumstances

thatmaybeofsignificanceforthehealth,adjustmentanddevelopmentofthechil

drenandadolescents;3)togainknowledgeaboutchildrensandadolescentsneed

for, and use of health services formental health complaints. For answering these

questions,anationwidesampleof400youngpeopleagedbetween12and23and

livinginchildwelfareinstitutionswillbestudied.Theprocedurefordatacollectionis

strictlydefinedandconsistsoftheadministrationofseveraldifferenttestsandques

tionnaires.

OneofthequestionnairesthatwillbeusedistheCommunityOrientedProgramsEn

vironmentScale(COPES),whichinvestigatestheperspectivesofusersandstaffcon

cerningtheinstitutionalenvironmentandtheprogramssocialclimate.Thisresearch

toolwillbethemainsubjectofthisreport.ThetheoreticalbackgroundoftheCOPES

isinvestigated,

using

relevant

literature

concerning

its

content

and

usefulness.

Fur

thermore,anoverviewwillbegivenofitsuseinchildwelfareinstitutions,includinga

critical reflectionon that.Abroad literature searchhasbeen conducted, regarding

oneofthethreeoverarchingdimensionstheCOPESismeasuring.


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2 ABOUTTHECOPES

2.1 WhatistheCOPES?

TheCommunityOriented Programs Environment Scale (COPES;Moos, 1974,1988,

1996,2003) isoneof thenineSocialClimateScalesdevelopedbyRudolfH.Moos.

These Social Climate Scales were developed gradually in the United States. The

COPESarearesultofavery longandcomplexresearchprocessofRudolfH.Moos.

Thisprocessisnicelysummarized inajournal interviewfrom2008.Inthis interview

(Journal Interview,2008),Moos states thathewas fascinatedby thepersonality

theoryandpsychoanalytical thinkingwhichposited thatone couldunderstandand

predictwhat

individuals

would

do

on

the

basis

of

their

personal

predilections

and

characteristics.Moos,however,doubtedthesetheories.Hethoughtthatthesetheo

riesoverlookedtheroleofenvironmentandsocialcontextasakeyinfluenceonhu

manbehaviour.TheseideasformedthebasisofMoosdevelopmentofmeasuresto

assess treatment environments. His first focus was on hospitalbased substance

abuseandpsychiatric treatmentprograms.Another importantdecisionMoos took

during thedevelopmentof themeasureswas toassess treatmentenvironmentsas

patients and staff perceived them. Quickly, the research expanded to community

programs,in

which

was

found

that

residents

and

staff

perceived

apparently

similar

communityprogramsquitedifferently.Themain ideaofthewholeresearchproject

was that treatmentenvironmentsarecomposedof threemainsetsofdimensions:

relationshipdimensions,personalgrowthorgoalorientationdimensionsandsystem

maintenancedimensions.Soon, itbecameclearthatthesethreesetsofdimensions

couldalsobeusedtocharacterizeothertypesofsocialsettings,likefamiliesorresi

dentialsettingsforolderadults.

Inthe

context

described

above,

Moos

thus

developed

the

Social

Climate

Scales

in

the

late1960sandthe1970s.TheseSocialClimateScalesoperationalizeandmeasurethe

underlyingdimensionsofdifferentkindsofsocialsettings.ThenineScales,whichare

partofthisassessment,arelistedbelow(figure1).


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Figure1.TheSocialClimateScales.

TheCOPES isthefirstscale inthisfigure,situated inthe listofCommunitysettings.

The intentionoftheCOPES istomeasuretheactual,preferredandexpectedtreat

mentenvironment

or

social

climate

of

community

treatment

programs.

Moos

(1972)

himselfsummarizesitasascalewhichattemptstosystematicallyassessthepsycho

social environments of transitional community oriented psychiatric treatment pro

gramssuchashalfwayhouses,rehabilitationcenters,daycarecentersandcommuni

tycarehomes.Itisusedtomeasuretheopinionsofbothserviceusersaswellasstaff

involvedincommunitytreatments.TheCOPESconsistofthreedimensions,eachcon

sisting of underlying subscales. The Relationship Dimension consists of three sub

scaleswhichmeasureInvolvement,SupportandSpontaneity.ThesubscalesAutono

my,Practical

Orientation,

Personal

Problems

Orientation

and

Anger

and

Aggression

makeupthePersonalGrowthDimension.Threeothersubscales,OrderandOrganiza

tion,ProgramClarityandStaffControlarethesubscalesoftheSystemMaintenance

Dimension. Important inthiscase is thatMoosandSchwartz (1972)andMoosand

Petty (1971)have shown that thedimensionsare related toobjective indicatorsof

treatmentoutcomesuchasdropoutrate,releaserateandcommunitytenure.Inthe

tablebelow,thereisanoverviewofthementioneddimensionsandsubscales.


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Table

1.

The

COPES:

Dimensions

and

Subscales.

Relationship Dimensions

1. Involvement (I)

2. Support (S)

3. Spontaneity (Sp)

Personal Growth Dimensions

4. Autonomy (A)

5. Practical Orientation (PO)

6. Personal Problems Orientation (PPO)

7. Anger and Aggression (AA)

System Maintenance Dimensions8. Order and Organization (OO)

9. Program Clarity (PC)

10. Staff Control (SC)

Inorder tomeasure theactual,preferredandexpected treatment, theCOPEShas

threedifferent formsofassessment.TheRealFormmeasuresmembersandstaffs

viewofthecurrenttreatmentprogram.Toassessindividualspreferencesaboutideal

communityoriented treatmentprograms, the IdealForm isused.The third form is

theExpectationsForm,whichmeasures individualsexpectationsaboutatreatment

programtheyareabouttoenter.Eachoftheformsconsistsof100questions,which

aretobeansweredwithtrueorfalse.Theformsaretobefilledoutbyusersandstaff

oftheprogram.

TheCOPES canalsobeused formore variedpurposes.Moos (1972) says that the

COPESmayidentifythoseindividuals,bothusersandstaff,whoshowdeviantpercep

tionsoftheirenvironment.OtherpurposesoftheCOPESaredescribedinthemanual

(Moos,2003):

Inaddition, researchers use the COPES to describeand compare treatment

programs,examinethedeterminantsoftreatmentclimates,andfocusonthe

connectionsbetweentreatmentclimatesandoutcomesforindividualmembers

andstaffandgroupsofmembersandstaff.


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2.2 MeasuringsocialclimatewiththeCOPES

AstheCOPESisoneoftheSocialClimateScales,itsmaingoalistoexaminethesocial

climate inacommunitytreatmentprogram.TheauthoroftheCOPES (Moos,1974;

1988;

1996;

2003)

constructed

a

conceptual

framework

about

the

relation

between

programandpersonal factorsand clientsoutcomes (figure2). From themodel, it

becomesclearthattherearedifferentdomainsofvariablesthatshouldbe included

inacomprehensiveevaluation.

Themodelisbasedontwomainconcepts(panelIandpanelII),whichareinfluenced

bythreeintermediatefactors.Thefirstpanelcontainstheobjectivecharacteristicsof

theprogram.These includetheaggregatecharacteristicsof residentsandstaff,the

programsinstitutionalcontext,thephysicaldesignofthesetting,andtheprograms

policies and services. In panel II, there are personal factors such as clients socio

demographic characteristics,health, cognitive status, functionalability, andprefer

ences.As shown in themodel, these twomain concepts influenceeachother.For

example,inthecontextofchildwelfareinstitutions,childrenwhoareatalowercog

nitive levelwillbe inanothereducationalprogramthanpeerswithmoreadvanced

cognitiveabilities.

Thesocialclimateisanoutgrowthofobjectiveenvironmentalfactors,butitalsome

diatestheir

impact

on

clients

function.

Still,

social

climate

is

placed

in

aseparate

panel,forhighlightingitsspecialstatus.Inaddition,accordingtoMoos,socialclimate

canbeassessedatboththeprogramandtheindividuallevel.


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Figure

2.

A

model

of

the

relationship

between

program

and

personal

factors

and

resident

stability

andchange.

Theobjectiveenvironmental factorsandpersonal factorsalsocombineto influence

clients inprogramoutcomes(panel IV)andtheiradaptation(panelV).Examplesof

inprogramoutcomesareclientssatisfaction, interpersonalbehaviourandprogram

participation.Theseoutcomesinfluencethecommunityadaptationasclientshealth

status,socialandworkskillsandpsychosocialfunctioning.Inturn,clientsadaptation

isalsoaffecteddirectlybystablepersonalfactors.

Moos&Lemke(1996)statethatthemodelhighlightsthefactthatanenvironmental

featurecanvary intheway itaffectsdifferentresidents. Inpanel I, themodelalso

incorporatesthecharacteristicsofthestaffandhowstaffinfluencethesocialclimate

andclientsinprogramandcommunityadaptation.

Panel I

OBJECTIVE CHAR-

ACTERISTICS OF

PROGRAM

Panel II

PERSONAL FAC-

TORS

Panel V

CLIENTS

COMMUNITY

ADAPTATION

Panel IV

CLIENTS

IN-PROGRAM

OUTCOMES

Panel III

SOCIAL CLI-

MATE


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2.3 HowistheCOPESusedintheResearchProgram?

In theprojectdescribed in the introduction, Mentalhealthofchildrenandadoles

cents inchildwelfare institutions,theCOPES isoneofthequestionnairesthat isto

be

completed

by

the

participating

adolescents

and

leaders

of

the

institutions.

The

list

ofallusedinstrumentscanbefoundbelow(table2).

Table2.Overviewoftoolsusedintheresearchproject.

Tests and questionnaires Area Informant

CAPA Child psychiatric interview Young person

CANTABeclipse Neuropsychology Young person

WASI Intellectual ability test Young person

Supplementary interview of

the young person

Care/school/treatment Young person

Questionnaire SDQ Emotional/behavioural

problems

Young person

SPPA Self-image Young person

DERS Emotion regulation Young person

KINDL Quality of life Young person

SSQ Social support Young person

SSRS Social functioning Young person/teacher

COPES Institutional environment The young person/institution

represented by head

Questionnaire about the insti-

tution

Objective information Institution represented by head

Interview about the young

person

ADHD/attachment disturbance/

Asperger

Institution represented by head

Questionnaire CBCL Mental health Institution represented by head

KINDL adult Quality of life Institution represented by head

Questionnaire TRF School - mental health Teacher

SSRS/Social Coping Social skills Teacher

Psychosocial difficulties Psychosocial difficulties Teacher

TSRI Teacher/student relationship Teacher


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Asnotedabove,therearethreeformsoftheCOPES(real,idealandexpected).Inthis

project,onlytherealformoftheCOPES isused.This isbecausetheprocedurealso

includesalotofotherquestionnaireswhicharetobeansweredbythechildrenand

the institution leaders.Therealform,which isabouttheperceivedsocialclimate in

theinstitution

at

that

particular

moment,

is

of

most

relevance

for

the

project.

TheCOPESwasoriginallydevelopedinEnglishbuthasnowbeentranslatedtoother

languages,includingNorwegian.TheNorwegiantranslationwasdoneasapartofthe

researchprojectonmentalhealthofchildreninchildwelfareinstitutions.Thetrans

lationfollowsascloselyaspossibletheoriginalEnglishversion.

ThechoiceofusingtheCOPESintheprojectwasmadebyprofessorMathewColton,

whowasthenaresearcherattheRegionalCentre forChildandAdolescentMental

Health.Hehasdoneextensive researchabout socialenvironmentsand considered

theCOPEStobeanadequatetoolfor investigatingchildrenandstaffsperspectives

about their institutional environment. In his research about foster and residential

childrens perceptions about their social environment,Colton (1989) used a Social

ClimateQuestionnaire (Heal, Sinclair& Troop, 1973) to investigate childrens per

spectives. This questionnaire was similar to the COPES. It is a bit shorter and

measuresslightlydifferent,yetrelateddimensions.Theauthorsofthisquestionnaire

alsoexplain

that

16

of

the

47

items

have

been

taken

more

or

less

verbatim

from

Moosquestionnaire.TheSocialClimateScaleofHeal,SinclairandTroop(1973)also

have other similaritieswithMooswork. The instrument consists of simple state

ments thatmustbe ratedwith trueor falseandthequestionnaire ismeasuringsix

subscales, including Staff Support, Strictness, Satisfaction,Boy Friendliness,Behav

iourandWork.

Data collection in the project has been done by research assistants, who travel

aroundNorwaytointerviewchildrenininstitutions.Therewereoriginallythreeassis

tants,butonenolongerworksontheproject.Theyadministerallthequestionnaires

intwodaystobesurethechildrenarefocusedduringthewholetest.TheCOPESis

thesecondinstrumentusedbecauseitisoneofthelongestinstruments.Theproce

dureismostlythesamewithallthechildren.First,theassistantstrytohelpthechil

drentofeelcomfortableandtalkalittlebitwiththemabouttheirlifeintheinstitu

tion.Theythengiveashort introductiononthetests. In this introduction,theyex

plainthatthequestionnaireisabouttheinstitutionandtheyclarifythetrueorfalse

answer

choices.

Most

of

the

children

fill

in

the

questions

by

themselves.

If

they

are,

however,notabletoreadthestatementscarefullyenough,theassistantsreaditfor


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them.Duringthetest,childrenareallowedtoasktheresearchassistantsquestions.If

theydontunderstandaparticularwordorquestion,theassistanttriestoexplainit

forthem.Also,ifthechildrenarestruggling,theassistantstrytomotivatethem.They

clarifythatitsabouttheviewofthechildhimself,notaboutgeneralfeaturesofthe

institution.If

the

children

dont

want

to

answer

acertain

question,

the

assistants

dont force them.Thoseblankquestionswillbeanalysedasmissing variables.The

leadersofthe institutionsarealsoaskedtofill intheCOPES. Inthiscase,theassis

tantsarenotpresentduringthetest.The leadersreceivethequestionnairebymail

andhave to send itbackwhencompleted.Theydonthave theopportunity toask

questions,ortogivecomments. Ittakesapproximately15to20minutestoanswer

therealformoftheCOPES.


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3 FOCUSONRELATIONSHIPDIMENSION

Intheprevioussection,theCOPESanditsuseintheresearchprojectweredescribed.

Aspreviously

discussed,

Moos

sees

the

three

dimensions

of

the

COPES

as

acharac

teric featureofdifferentsocialsettings.The firstdimensionof theCOPESconcerns

staffandchildrensviewsondifferentaspectsof relationships in the institution. In

thissection,wewillfocusonthisdimensionbyreviewingrecentliteratureaboutits

underlyingconcepts,situatedinthecontextofresidentialcareandinstitutions.There

are threemainsubscales in theCOPES thatconstitute the relationshipdimensions.

TheseareInvolvement,SupportandSpontaneity.QuestionsintheCOPESconcerning

Involvementaresupposedtomeasurehowactiveandenergeticyoungpeoplearein

theprogram.Anexampleofaquestioninthissubscaleisifmembersputalotofen

ergyintowhattheydoaroundtheinstitution.ThesubscaleSupportintendstoassess

howmuchyoungpeoplehelpandsupporteachotherandhowsupportivethestaff

are towardsyoungpeople.Oneof thequestions in this subscale is if thehealthier

youngpeoplehelptakingcareofthelesshealthyones.Anotheraspectthatismeas

uredishowmuchtheprogramencouragestheopenexpressionoffeelingsbyyoung

peopleandstaff.ThisthirdsubscaleiscalledSpontaneity.Anexampleofaquestion

inthissubscale is ifyoungpeopletendtohidetheirfeelingsfromoneanother.We

willdiscussthesethreesubscales(table3)below.

Table

3.

The

COPES:

Relationship

Dimensions.

Relationshipsarecrucialwhenitcomestoresidentialcare.Itcanbeareasonforchil

drentoenterspecialcarefacilitiesduetoadysfunctionalrelationshipwiththeirpar

ents,orbecausetheycannotmakeadequatecontactwithpeers.Therefore,itisim

portantthatchildreninresidentialcarecanbuildsolidandhonestrelationshipswith

theirstaff.

As

the

COPES

measures

childrens

and

staffs

perspectives,

it

is

important

Relationship Dimensions

Involvement (I) How active and energetic young people are in the program.

Support (S) How much young people help and support each other and how sup-

portive the staff are towards young people.

Spontaneity

(Sp)

How much the program encourages the open expression of feelings by

young people and staff.


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tofocuson literaturethatreviewschildrenandstaffsviews.AsthestudyofDavies

andWright (2008) confirmed, children in care are able to commenton their own

therapyandexperienceofmentalhealthservices.Itisoftenforgottenthatevenvul

nerablechildrenwithsupportarecompetenttodothis.

3.1 Involvement

Perspectivesofmembers and staff concerning involvement in treatmentprograms

vary across different literature sources.Mostly, it is found that clients value non

verbal interactions more than group activities. However, they do think relational

componentsareofgreat importance intreatmentprograms. Inwhat follows,some

differentviews

of

clients

are

described.

It isquiteremarkablethatBiancosino,Barbui,Pera,Osti,Rocchi,MarmaiandGrassi

(2004),whoadministeredtheOpinionsonCurativeFactorsQuestionnaire(OCFQ)to

asampleof157severelyillpsychiatricpatientsinthenorthofItaly,foundthatclients

in residential psychiatric care considered verbal group activities as being not that

helpful.Thepatientsinthisstudywereaged21to77yearsold.Inthisinvestigation,

the lowestranked interventioncomponentsweredailymeetingsontheward,com

munitymeetings,

treatment

team

meetings

and

group

therapy.

From

this

study,

it

seems likepatientsdonotappreciatejointcommunityactivities.Theauthors think

thismightbebecausetheseaspectsdonotallowcohesivegroupstodevelopanddo

notallow individualproblems tobeaddressed.Patientsdescribed,however,other

specificmodalitiesof treatment as veryhelpful. Thesewere talkingwithadoctor,

medication,visitors,nonhospitalsettingandfreepass.Theauthorsdefinetheseas

pectsas theones thatoffer theclientsahomelikeenvironment. In this study it is

concluded thatpsychiatricpatients rate factorsbasedon individual approaches as

veryhelpful,

as

well

as

aspects

of

the

therapeutic

milieu

that

assure

few

restrictions,

no stigmaand interactionswith theoutsideworld.Thoughmostof thepatients in

thisstudywereolderthentheyoungpeopleinourstudy(1223years),thereissome

overlap inageandtherefore it ischosento includethisstudy inthisreport.Similar

findingsaredescribedinthestudybyDaviesandWright(2008;seefurther),inwhich

childrenacknowledgethevalueofnonverbalinteractions(e.g.drawing,playing).

Only fewstudieswere foundwhichexaminedtheviewpointofchildrenthemselves

specifically

on

the

involvement

in

treatment

programs.

Aubrey

and

Dahl

(2006)

re

vealthatthosemakingdecisionsabouttheirlivesdonotalwaysaskchildrenfortheir


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views.However,Mason (2008)statesthatchildren from8to18years inAustralian

outofhome care emphasise the importance of being able to influence and have

somecontroloverconnectionswithothersandthewaytheylivetheirlives.Mullan,

McAlister,RollockandFitzsimons (2007) reportthat lookedafterchildren inNorth

ernIreland

(12

to

25

years

old)

sometimes

see

talking

with

staff

as

apositive

mean

of

copingwithdifficult feelingsandsituations. Inthisstudy,theyoungpeoplealsore

portedseveral factors thatare important foragoodcareexperience.Forexample,

theadolescents saw supporting family relationshipsandhavinganumberofother

social relationshipswhile in care as being very important. In the following section

aboutsupport,itwillbecomeclearthatthisisarecurringfindinginliterature.

Concerningtheinvolvementinprograms,youngpeoplewereverycriticalofmanyof

thepolicies,

procedures

and

the

rules

in

the

residential

care

facility.

They

all

experi

encedLACreviews1asverynegativetothemselves.Manyyoungpeoplequestioned

thenecessityofalltheexistingproceduresandpolicies,becauseitoftentakesaway

theirsenseofnormality.Nexttothisdoubtaboutpolicyandprocedures,theyoung

people state that leisure space; time and activity are valuable for good emotional

health.Italsoprovidesasenseofachievement,whichisimportantforchildrenwith

low selfesteem.Obviously, stabilityofplacementwasalso an important aspect in

thechildrenslife.

DaviesandWright (2008) found that lookedafter childrendovaluemeaningful in

volvement in their therapy, and that they want a voice in decisions about their

treatment.Theyreviewed14articlesaboutchildrensexperiencesofmentalhealth

servicesintheUK.Thestudywasbaseduponthevoicesof200childrenofdifferent

ages. Itbecameclearthatchildrencouldmeaningfullycommentonthetherapeutic

process, identifyingaspectsthattheyfeltwerehelpfulandunhelpful, includingpar

ticulartechniques.Aconsistentfindingacrossmodalitiesandagegroupswastheval

ueof

non

verbal

interactions

to

be

engaged

in

therapy.

For

many

children,

the

au

thors say, talking is a sourceof challenge anddiscomforteven though it could be

helpfulandvaluable.Inpractice,nonverbalcommunicationsaremostlyseenasob

vious and neglected, instead of being a central therapeutic activity. As it is now

shown thatyoungpeople (Biancosino,Barbui,Pera,Osti,Rocchi,Marmai&Grassi,

2004) as well as children value this type of intervention, it is important to

acknowledgethisthemeinthetrainingofmentalhealthprofessionals.

1LAC

reviews:

A

Looked

After

Child

(LAC)

Review

is

ameeting

to

discuss

the

care

of

ayoungster

in

an

institu

tion.Themeetinglooksatthepracticalarrangementsforthechildandmakesplansforitsfuture.


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14

Thatchildrenandyoungpeoplearemoreinterestedin informalprocessesbasedon

personalrelationshipswithcarerstheyknowandtrustratherthaninformalprocess

es isalsodescribedbyCashmore (2002).Herarticleaboutpromotingtheparticipa

tionofchildrenandyoungpeople in care reviews research literature from theUK,

NorthAmerica,

Australia

and

New

Zealand.

She

says

that

children

are

not

seeking

selfdeterminationortocontrolthedecisionmaking;theydo,however,wanttobe

informedandinvolvedintheprocess.

From literature, it isquiteclear thatpatientsvalue relationalcomponentsof treat

mentprograms.Supportfromstaffseemstobeasignificantcomponentforsuccess

intreatmentprograms(cfr.nextsection).Specificallyconcerningtheinvolvementof

clientsinaprogram,thereviewedliteraturesuggeststhatchildrenandyoungpeople

incare

generally

wish

to

be

more

involved

than

they

usually

are

in

the

way

decisions

are made about them. Cashmore (2002) adds that they especially like to decide

where they live and how often they can see familymembers.Weve also shown

abovethatclientsprefera lessrestrictivesetting, forexample freewalking,visitors

andhavingfreeholidays.

3.2 Support

Itisquitecommontoreadinliteraturethatchildreninresidentialcarecitetheposi

tive relationships with staff as central to their care experience (Mason, 2008;

Kendrick,Steckley&Lerpinier,2008).Somestudiessuggeststhattherapeuticorienta

tion might be secondary to other factors in identifying effective therapies (Stiles,

Shapiro & Elliot, 1986). Being heard and understood by staff might be more im

portant to children than therapeutic responsiveness (Davies&Wright,2008).With

this inmind,the investigationofthe relationshipbetweenstaffandusersbecomes

moreimportant,

because

negative

relationships

in

mental

health

institutions

can

have negative consequences for both staff and children. Rose, Madurai, Thomas,

DuffyandOyebode(2010)foundoutthatthereexistsasignificantrelationbetween

someburnoutand reciprocitymeasures.Negative relationships canbeharmful for

children too, since there is evidence that some children and adolescents aremal

treatedbytheircaregiverswhileinstatecare(AttarSwartz,2011).

In this section, the perspectivesof children are discussed first, followed by staffs

views.

Gallagher

and

Green

(2012)

interviewed

16

young

adults

who

had

been

placed

inatherapeuticchildrenshomeinEngland.Mostofthechildrenweremaltreatedin


22/51

15

earlychildhood,sotheysometimesdisplayedattachmentissuestooneorbothpar

ents. In general, theadolescentswerepositive about their relationshipswith staff

andthecontacttheyhadwithstaffafterleavingtheinstitution.Acrucialfindingwas

thatallofthe16participantsstatedthattheyhadbeenabletoformapositiverela

tionshipwith

at

least

one

member

of

staff.

The

authors

note

that

it

is

possible

for

these children to establish positive relationships with staff. The interviewees de

scribeda lotofbenefits from the relationships, including feeling safeor cared for,

havingapersonwhomtheycouldtalktoorplaywith,trustand friendship.Several

adolescentsindicatedthattherelationshipwiththestaffhelpedthemdealwiththe

emotionalandbehaviouralchallengestheyhadfaced.AnotheraspectGallagherand

Greenstudied,wastheremainingcontactwiththestaff,aftertheyoungadultshad

lefttheinstitutions.Theydiscoveredthat14ofthe16participantswerestillintouch

withatleastonememberofstaff,afteronaverage5,9yearssinceleavingthehome.

Theauthorsconcludethatisitveryclearthatrelationshipscanhaveaprofoundrole

inthelivesofchildreninresidentialcare.

Asalreadystated inthesectionabout involvement,Mullanetal. (2007)foundthat

supportfromfamilyandcareworkersisthemost importantforagoodcareexperi

ence,accordingtoyoungadultsinresidentialcareinIreland.Therewas,however,a

discrepancyinwhomtheadolescentssawasmostimportantandwhomtheysawas

mostsupportive.

Mostly

the

foster

carers,

key

workers,

co

workers,

aftercare

work

ers,teachers,siblingsorfriendswereidentifiedasmostsupportive.Theyoungpeo

pledescribeddifferentaspectsofasupportiverelationship,suchastheworkerknow

ingtheyoungpeoplewell,beingopenandfriendlyandbeingableandwillingtolis

ten.

Inadditiontotheexperiencesofchildren,itisalsoimportanttolookattheviewsof

leadersandstaffaboutsupportiverelations in institutions.Hicks(2008)studiedthe

roleof

leaders

in

childrens

homes

in

the

UK.

It

was

revealed

that

it

is

crucial

in

chil

drenshomesthatthemanagerisacceptedasembodyinggoodpracticefromwithin

a clear ethos and had positive strategies forworking both with the behaviour of

youngpeopleandinrelationtotheireducation.Thestudyalsofoundthatthewayin

whichtheroleofmanageriscarriedoutisvitallyimportantintermsoftheoutcomes

experiencedbyyoungpeople.

Rose,etal.(2010)askedstaffmembersintheUKtoreporttheirperceivedreciprocity

in

the

relationship

they

had

with

service

users,

other

staff

and

the

organisation

they

workedfor.Theresultsshowedthatmostoftheresidentialcareworkersperceived


23/51

16

themselvesasinvestingmoreintherelationshipwiththeserviceusersthantheyre

ceivedinreturn.Thestaffreportedthattheyexperiencemostreciprocitywithother

staffworkers,morethenwiththeserviceusers.Theorganisationalrelationshipwas

theoneinwhichtheyreportedthattheyexperiencedtheleastreciprocity.

3.3 Spontaneity

IntheCOPES,thelastsubscaleoftherelationshipdimensionmeasureshowmuchthe

programencouragestheopenexpressionoffeelingbymembersandstaff.Theques

tionsinvestigateforexamplehowopenlychildrendaretotalkabouttheirfeelingsto

stafforhowoftenchildrencandowhattheyfeellike.Wefoundlittleliteratureabout

feelingsand

emotions

in

child

welfare

institutions.

Most

articles

concern

organisa

tionalandpracticalissues,ratherthantalkingaboutchildrensandstaffsfeelingsand

emotions.Itisprobablyadifficultissuetoassessinthefield.Also,whilereadingarti

clesaboutrelationshipsbetweenstaffandusers,itwasnoticeablethatpeopledont

mind talkingabout the relationship itself,but theaspectof the feelings theyhave

aboutcertain relationships ismostly leftunspoken.However,a fewarticlesdo talk

brieflyaboutthissubject.

Inthe

study

of

Mullan,

et

al.

(2007),

which

was

referred

to

before,

issues

of

confiden

tialitybetweenmembersandstaffarealsodiscussed.Theyoungpeopleinthestudy

werebetween12and17yearsoldandLookedAfteroraged18 to25yearsand

entitledtoLeavingCareServices.TherewerefourcareservicesinvolvedinNorthern

Ireland, resulting inaparticipantgroupof51youngsters.Theyoungpeople in the

studydemonstratedakeenunderstandingof the importanceofconfidentiality, the

authors say.Some felt thatproblemshadarisendue theprocessof confidentiality

notbeingadheredtoandthustrustbeingbreached.Youngpeoplefeltthattheshar

ingof

information

needed

to

be

more

explicit

regarding

what

the

person

was

passing

on, towhomandwhy.They stated that trust thathasbeenbreachedhadadetri

mentaleffectonthelikelihoodofsomeyoungpeopleopeningupagain.Theauthors

alsoaddthatsomeprofessionals,inordertoprotectthemselves,mayfeelthatthey

have topassall informationon.But therehas tobeanopportunity for theyoung

peopletotalkaboutconfidentialinformationinprivate.Theauthorsthussaythata

greatertrustandresponsibilityneedstobegiventoprofessionalstousetheirprofes

sionaljudgementmorefreelyinkeepinginformationprivateandconfidential.Mullan,

etal.

(2007)

conclude

that

the

most

clear

message

of

their

research

is

the

need

to


24/51

17

understand attitudes, experiences and behaviours of the young peoplewithin the

contextof their lives.Theyoungpeople in carehaveemotionalneeds,yet the re

searchhas shown that theirexperiencesbefore care,duringcareand indeedafter

careintensifythoseneeds.

Inaliteraturereviewaboutpromotingtheparticipationofchildrenandyoungpeople

incare,Cashmore (2002)quotes some remarkable statements fromchildrenabout

supportandtrustincare.HerreviewconsistsofliteraturefromtheUK,NorthAmeri

ca,AustraliaandNewZealandandexplores theperceptionsof childrenandyoung

people incareconcerningtheextenttowhichtheyhavebeenabletoparticipate in

decisionsthataffectthem,thereasonstheywanttodoso,andwhat isrequiredto

make iteffective.Cashmore(2002)statesthat inanumberofstudies,childrenand

youngpeople

have

said

they

want

agenuine

and

personal

relationship

with

a

workerwhocaresaboutyou, listensandactuallyknowswhoyouare,someone

whodoesntthinktheyknowwhatsbest,justbyreadingthefile.

IntheliteraturesynthesisofDaviesandWright(2008)itbecomesalsoclearthatstaff

sometimes does not take the feelings of children seriously. When children were

askedforsuggestionsandimprovementsintheirtherapeuticprogram,theyempha

sisedthattheywanttheirsuggestionstobereceivedwithduerespectandconsidera

tion.The

children

also

considered

trust

and

adegree

of

control

in

choosing

what

to

talkaboutashelpfulforfacilitatingcommunicationwithcaregivers.

Ifwewanttoevaluatehowstaffthinkaboutspontaneityincaringrelationships,itis

importanttomentionthatstaffwillalways lookattherelationshipfromadifferent

perspective.Bickmanetal.(2004)saythatthis isalwaysthecase,regardlessofthe

duration of the relationship or the frequency of contact between both parties.

Vanderstraeten and Standaert (2008) investigated the experience of the relations

betweenyoungpeopleandstaffinguidancehomesinBelgium.Theyfoundthatstaff

mostly say that theyexperiencea good relationshiporeven a therapeutichelping

relationshipwiththeadolescent,whiletheadolescents incontrastsaythattheyex

periencenofeelingofarelationship.

Another important feature of spontaneity in a relationship is the degree of self

disclosure both the parties of the relationship allow. More indepth information

aboutthissubjectcanbefoundinthestudyofBurkard,Knox,Groen,PerezandHess

(2006). In the lightof staffperspectives, it is interesting to read in this study that

therapistsreported

self

disclosure

as

improving

the

therapeutic

relationship.

Thera


25/51

18

pistsalsotypicallyreportedthattheselfdisclosurehelpedclientstofeelunderstood

andallowedclientstoadvancetootherissuesinpsychotherapyorintheirlives.


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19

4 THE USE OF THE COPES WITH CHILDREN AND YOUNG

PEOPLE

4.1 StudiesusingtheCOPESwithadolescents

Asdiscussed in the firstchapter,Moosoriginal targetgroup for theCOPESwason

substanceabusingadolescents.However,MooswritesinthemanualthattheCOPES

canbeused inabroad rangeof community treatmentprograms.Wedidnot find

many studies inwhich theCOPES isusedwith children.Mostof the literaturewe

foundontheCOPESandyoungpeople, isaboutadolescents inadrugabusetreat

mentprogram. In thisproject,however, the interest isonchildren inchildwelfare

institutions.Some

studies

on

the

COPES

in

this

setting

(residential

care)

were

found

(table4),although this cannotbeanexhaustive list.Theoverview isbasedon the

bibliographybyMoos(2006)andourownlimitedresearch.Theonlyinclusioncriteria

were that the studyhas tobeaboutchildrenoradolescents,and that thestudy is

about residential care services.However,mostof the settings in these studiesare

large group home settings, not only consisting of young people. Brunt and Rask

(2012)mentionthatthereareonlythreestudies,reported in internationaljournals,

thathavebeenperformedwiththeCOPES insupportedhousing/smallgrouphome

settings.Inthetablebelow,thosearemarkedwithanasterisk(*).


27/51

Table4.StudiesabouttheuseoftheCOPESwithyoungpeopleinresidentialcare

Study Sample Institution type Use of the COPES

Brunt & Hansson

(2002a) *

33 persons

aged 18 to 55

Group homes As part of research

by local authorities

illness the characte

ment was investiga

sions of the Commu

ronment Scale (CO

residents and staff

county in southern S

Brunt & Hansson

(2002b) *

51 persons

aged 18 to 55

Group homes The study showed

ronment differs betw

Residents and staf

dences rated higher

er levels of Practica

gression and Orde

tients and staff in inp


28/51

21

Cavicchia (1983) Adolescent group

homes

Disagreements betw

administrators helpe

levels of intrastaff an

Friedman, Glickman &

Kovach (1968a)

482 adoles-

cents

Residential drug abuse

programs

Compared to clients

grams, clients and

rated them as m

structured and as hi

al problem orientatio

anger. Staff in both

appraise the treatm

tively than clients drated the program e

than women staff.

reports of woman

similar to the reports

Friedman & Glickman

(1987)

2500 adoles-

cents

Residential drug abuse

programs

More successful pro

lors as more sponta

open expression ofphasis on client inde


29/51

22

Gilmour-Barrett (1974) Residential centres for

disturbed youth

There were strong c

COPES relationship

workers reports of

with the youth.

Golden (1974) Psychiatric halfway

house for adolescents

The real and ideal

used to help improv

way house for adole

Johnson (1981) 3 groups of 15

staff

Residential cottages for

emotionally disturbed

adolescents

Staff group cohesion

degree of support,

personal problem ortreatment environme

hesion was negativ

staff control. High s

sary to foster ther

milieus.

Kohn, Jeger & Koretzky

(1979)

320 adoles-

cents

Treatment centre for

emotionally disturbedand delinquent adoles-

cents

Principal componen

sets identified two versus disinterest a

ganisation.


30/51

23

Lemke & Moos (2002) 432 young or

middle-aged

patients

Residential alcoholism

treatment programs

Older patients repo

port and organizatio

gression, than thei

Overall, patients wh

the program had b

This was as true for

younger patients. Th

patients with alcoho

ed in age-integrat

treatment milieu so

middle-aged and y

spond similarly to th

McKinney (1987) Group home The adolescent clie

programs emphasiz

staff control. Compa

institutional facility h

anger and less pers

olescents and their

agreed closely on therage, they saw it a

ward achievement,

and a moral religious


31/51

24

Middelboe (1996) * Group home Descriptive study in

Morehouse & Tobler(2000)

232 adoles-cents

Residential program According to the Clow to moderate em

mensions, on auton

and on order and

emphasis on the e

control. Overall, the

tive social climate th

specifically, staff r

support, order, and cdifferences in social

those that were m

youngsters alcohol

rienced and stable

have a more positive

Phillips, Coughlin, Fix-

sen, & Maloney (1979)

Boys home The COPES showed

itive changes (that

came closer to the "

group home environ


32/51

25

Rivard, Bloom,

Abramovitz, Pasquale,

Duncan, McCorkle &

Gelman (2003)

61 adolescents Residential program The programs wer

Model, which posits

to occur within the

stable, and socially

munity. Consistent

pared to standard re

tuary Model progra

ment, support, spon

entation, and a safe

tuary specific ideals.

Rivard, J. C., Bloom, S.L., McCorkle, D., &

Abramovitz, R. (2005).

87 adolescents Residential program The two groups of rrable at baseline; ho

the Sanctuary Mode

port, spontaneity, a

orientation, and a s

Models specific goa

ings, youth treated

developed a strong

and less antagonisti


33/51

26

Schneide, Kinlow, Gal-

loway & Ferro (1982)

10 adolescents Group home Both youths and sta

in their homes as m

ideal teaching famil

gram change. In ess

a more open, yet mo

Shinn (1982) Group home The process was su

tions of program cli

showed reliable imp

to their own baselin

homes. However, thto individual outcom

not affected. The pro

stable homes where

trol over important d

tive evaluation effor

responsive to the c

bers and instill prob

in participants.


34/51

27

Shinn, Perkins & Cher-

niss (1980)

Group home Staff perceptions o

mental homes show

time relative to the

one successful hom

were greater on d

during the developm

sions not so targeted


35/51

4.2 CriticalreflectionofusingtheCOPESwithchildren

Basedupon thepreliminary findingsof thestudy, it isclear that theCOPES isa

veryuseful instrument formeasuring the social climate in childwelfare institu

tions.There

are

only

few

instruments

that

focus

on

the

views

of

both

clients

and

staffon thisbroad rangeofvariables.As theCOPES ismostlyusedwithadults,

therearehoweverafewproblemsthatarisewhenconductingthetestwithchil

drenandyoungadolescents inacareprogram. In thissection,some reflections

onthisaregiven.ThesereflectionscameupwhendoingresearchontheCOPES

anditsuseinthisproject,andareworthwhilecommunicating,inthelightoffur

therresearchwiththeCOPESonchildren2.

InthemanualoftheCOPES,therearenoagerequirementsforthosetakingthe

test.Itsaysthatreadingskillsmustbeonasufficientleveltobeabletoreadand

comprehendthestatements.This isabsolutelyarequirementwhencarryingout

theCOPESquestionnairewithchildren. In this researchproject,notallchildren

hadareadinglevelthatwassatisfactoryforunderstandingthestatements.Inthat

case,theassistantsreadthequestionstothem,whichtakesalotmoretimethan

isusuallyprovided.Also,thechildrencaninterpretthequestionsdifferentlywhen

theyareread tothem.Tobesurethat thetest isobjectivelytaken,allchildren

shouldbe

provided

with

the

same

help

and

conditions.

In

this

project

it

was

de

cidedthatthequestionsshouldbereadtothechildreniftheyarenotabletodo

thatthemselves.Also,whiletakingthetest,childrencanask forsomemoreex

planationaboutthequestionstheydontreallyunderstand.

Inadditiontohavinganadequatereadinglevel,childrenalsohavetobeableto

comprehendthespecificcontentofthequestions. Inthisproject,theassistants

noticed thatsomeof thequestionscontaindifficult language thatmightbe too

complicatedforchildrentounderstand.Thiscanbearesultofthetranslationof

2Apilotstudyhasalsobeencarriedouttofindoutaboutthestrainontheyoungpeoplefromparticipat

ingintheresearchstudy(includingfillingouttheCOPESform),andwhetheranythingcouldbeimproved.

Tenyoungpeople,theirmaincontactpersons,andtheleadersoftwoinstitutionswereinterviewedabout

theirexperiences.Themainfindingwasthatthestudyshouldbereduced insize(fewerquestionstoan

swer), the researchassistantsmustbepresent in theroomwhere thequestionnaires (includingCOPES)

arebeing filledoutby theyoungpeople, so that they can receivehelp/advice, regularbreaksmustbe

included,anditshouldbeconsideredwhetherparticipationinthestudyistoodifficultfortwelveyearolds

(Ulset 2011). After the pilot study several changesweremade in the research procedure including a

changein

the

order

of

filling

out

the

survey

instruments,

in

order

to

ensure

that

COPES

is

filled

out

in

the

beginning,andincludedintheminimumsetofresponsesfromtheyoungpeople.


36/51

29

thequestions intoNorwegian.However, this isprobablynot the case,because

the translationwasdone very accurately,without changing the contentof the

questions.Theassistantsalsoreportthat it ismostlythesamequestions,which

arenotunderstoodbythechildren. Intheoverview(table5)given,thedifficult

statementscanbeidentified,aswellasthereasonwhythechildrendontunder

standthesequestions.

Table

5.

Difficult

statements

in

the

COPES

Allthetopicsmentionedabove,areespecially importantwhenthetargetgroup

containschildrenwithspecialneeds. Inthiscase,youhavetotake intoaccount

thatthosechildrenmightfunctionataloweragelevel.Adaptationsintheproce

durecanbemade,likereadingthequestionstothechildren.Likewise,thedegree

of difficulty of the statements has to be considered for these children. Some

wordsintheoriginalquestionsaredifficulttounderstandfornormallydeveloped

adolescents,sothiscanbecertainlyaproblemforchildrenwith,forexample,in

tellectual disabilities.When using the COPES, it is of great importance that all

childreninresidentialprogramscangivetheirviewsonthesocialclimate.Toen

sure that, someadaptations to theCOPES shouldbemade.However,wemust

addthatmostofthestatementsoftheCOPESareveryrelevantforapopulation

ofchildrenandyoungpeople.Revisionsforchildrenshouldfocusonthephrasing

ofthestatements,aswellasthemethodforanswering.

Anotherissuetheassistantsinthisprojectnoticedisthattheconcentrationofthe

childrencan

sometimes

be

disturbed

during

the

completion

of

the

questionnaire.

Statement Difficulty

11. This is a lively program Language: understanding

of the word lively

20. The staff very rarely punish young people by taking

away privileges

Language: understanding

of the word privileges

75. Young people are taught specific new skills in this

program

Content: understanding the

meaning of the statement

83. Members tend to hide their feelings from staff Content: it cannot be gen-

eralised.

87. Staff here think it is a healthy thing to argue Content: understanding the

meaning of the statement


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30

Itcanbehard forchildrentoconcentratewhilereadingandthinkingabout100

statements.Specifically in thisproject, therewerealsoother tests tobe taken.

Theassistantsmentioned that theyalwaysadminister theCOPESas the second

instrument,because it isa test thatrequiresa lotofeffort fromthechildren in

termsofconcentrationandattention.Becauseofthis,ashortformoftheCOPES

hasbeendevelopedtoenableprogramevaluatorstoobtainamorerapidassess

mentofaprogramstreatmentenvironment.Maybethiscanbeconsideredtobe

amore suitable form for children, so that biases of nonconcentration can be

avoided.However, thismightnotgivea complete representationof the childs

viewanddoesnotsolvetheproblemofthedegreeofdifficultyoftheformulation

ofthequestions.AmethodologicalreviewofthisshortformwasdonebyBrunt

andRask(2012),wherebytheysuggestarevisionforitsuseinsupportedhousing

facilities.

Whenevaluating childrensand youngpeoplesperspectives froman individual

study,itcanbeusefultocomparetheirviewswitharelevantnormgroup.Inthe

researchprojectdescribed inthis report, the initialanalysiswasdoneusingthe

children'srawscores,ratherthanthestandardscoresdevelopedbyMoosandhis

associatesintheUnitedStates.Thenormativesample,asdescribedinthemanual

(Moos,2009), isbasedonover200 communityprograms,mostly from theUS,

andmostly

aimed

at

users

in

psychiatry,

substance

abuse,

homeless

services,

halfway houses and similar programs. The standardized scores based on this

normalpopulationwerenotconsideredtoberelevantforusewithapopulation

ofchildrenandyoungpeopleinresidentialcareinstitutionsinNorway.TheCOPES

manualdoesnotstatespecificallywhichagegroupisusedinthenormativesam

ple,butmanyoftheprogramsappeartobeaimedmainlyatadults.Itisquiteevi

dentthatageisnotthemostimportantfeaturetakenintoaccount,whenmeas

uring the socialclimateofaprogram.Since theCOPESwasused in thecurrent

studytofindoutaboutchildrensviews,itisimportanttocomparethiswiththe

opinionsofchildrenofasimilarage.

Despite thecommentsabove, theCOPEShasa lotofbenefitswhichcannotbe

foundinotherevaluationinstruments.Forexample,theCOPEScanmeasurethe

viewpointsoftheusers,aswellasthoseofthestaff,withthesamequestionnaire.

It isorganised indifferentdimensions,whichprovides theopportunity to com

parethethreemaincomponentsofthesocialclimateofaninstitution.Itisatthe

sametime

possible

to

split

those

dimensions

into

different

subscales

to

look

clos


38/51

31

eratdifferent aspects.Another advantage is that theCOPES includespersonal

factors,aswellasorganisationalfactorsofaprogram.Thequestionnaireincludes

statementsaboutindividualusers,abouttheinteractionbetweenindividualsand

aboutpracticalfeaturesintheinstitution.ThequestionsareansweredonCOPES

with repliesofeither trueor false.This canbe seenasadisadvantage, since it

doesnotallowformoredifferentiatedreplies,butitisalsohelpfulinreducingthe

timerequiredtocompletethesurvey.Theseareonlyafewofthebenefitsofthe

COPES,whichinthisprojectwasfoundtobeveryuseful,whilebearingtheabove

reflectionsinmind.


39/51

32


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33

5 DISCUSSIONANDSUMMARY

Inthisreport,anattemptwasmade todescribetheuseoftheCommunityOri

entedPrograms

Environment

Scale

(COPES;

Moos,

1974,

1988,

1996,

2003)

in

childandadolescentresidentialcareservices.Atfirst,somegeneral information

abouttheCOPESwasprovided.Atheoreticalframework,concerningtherelation

shipbetweenprogramandpersonalfactorsandresidentstability,wasdiscussed

toprovidemoreinsightinmeasuringsocialclimateusingtheCOPES.Afterwards,

theuseoftheCOPESinthecurrentproject:MentalHealthinChildrenandAdo

lescentsinChildWelfareInstitutionswaspresented.

Inthe

second

part

of

the

theoretical

background,

literature

about

relationships

betweenstaffandadolescentsininstitutionswasdiscussed.Thisliteratureisrel

evantasitrelatestothefirstdimensionoftheCOPESwhichfocusesonthreepar

ticularconceptsregardingrelationships Involvement,SupportandSpontaneity.

Findingsaboutthesethreeconceptswerealsodiscussedinthischapter.

In the next section, more information was given about the use of the COPES with

children and young people. First, an overview of studies concerning the COPES

and its use in residential care with children was provided. Second, some reflec-tions on the use of the COPES with children were discussed, based on an inter-

view with the research assistants working on the research project.

Fromliterature,itwasshownthatchildreninwelfareinstitutionsvaluerelational

componentsof treatmentprograms (Mason,2008;Davies&Wright,2008).Alt

houghsomestudiessaythatusersprefernonverbal interactions (Biancosinoet

al.,2004;Davies&Wright,2008),theyalsothinkmeaningfulinvolvementinther

apyis

of

great

importance.

A

recurring

finding

is

that

children

and

adolescents

see

talkingwithstaffandtherelationwiththemasthemostimportantfeatureofres

identialcare(Mason,2008;Mullan,McAlister,Rollock&Fitzsimons,2007;Cash

more,2002).Theyvaluetheserelationshipsmorethanthetherapeuticaspectsof

theinstitution.However,DaviesandWright(2008),pointoutthatthoserelation

shipscannotbeforced.Formanychildren,talking isachallengeandasourceof

discomfort.Nexttothis,anoftenheardcommentoninvolvementisthatchildren

wish tohavemoreparticipation in the, sometimes lifechanging,decisions that

aremade

about

them

(Mason,

2008;

Cashmore,

2002).


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34

Childrenseesupportfromthestaffasbeingveryhelpfultotheircareexperience.

In a lot of studies (Mullan,McAlister, Rollock& Fitzsimons, 2007;Gallagher&

Green,2012),childrenindicatethattheirrelationshipwiththestaffhelpedthem

dealwithemotionalandbehaviouralchallenges.Theyseetalkingwithstaffasa

positivemeansofcopingwithdifficultfeelingsandsituations.Mullanetal.(2007)

gaveadescriptionofwhatyoungpeople seeasa supportive relationship.They

wantthecaregivertoknowthemwell,tobeopenandfriendlyandtobeableand

willingtolisten.Fromthestaffsview,itisfoundthatmostcareworkersperceive

themselvesasinvestingmoreintherelationshipwiththeserviceusersthanthey

receivedinreturn(Rose,etal.,2010).

An important issue in childwelfare institutions is howmuch the social climate

allowsthe

open

expression

of

feelings

by

members

and

staff.

In

this

light,

confi

dentialityand trustplayan important role.Mullan,etal. (2007)concludes that

thereisaneedtounderstandattitudes,experiencesandbehavioursoftheyoung

peoplewithin the context of their lives. Young people in care have emotional

needs, yet research has shown that their experiences before, during and after

careintensifythoseneeds.Mullan,etal.(2007)alsosaysthatstaffmustbegiven

agreaterresponsibilityandtrusttousetheirprofessionaljudgementmorefreely

inkeepinginformationprivateandconfidential.Thisisimportant,becauseyoung

peoplein

care

feel

that

trust

that

has

been

breached

had

adetrimental

effect

on

thelikelihoodofopeningupagain.Fromstaffviews,itisshownthattheyseeself

disclosureasimprovingthetherapeuticrelationship.Theyreportthatithelpsad

olescentstofeelunderstoodandallowsclientstoadvancetootherissuesintheir

lives(Burkhard,Knox,Groen,Perez&Hess,2006).

Theabovementionedfindingsindicatethattheconceptofrelationshipcannotbe

left unnoticed in childwelfare institutions. Young people in care should be in

volvedin

decisions

about

their

lives,

and

more

emphasis

should

be

placed

upon

thedevelopmentofpositive relationswith staff.As this seemsmore important

thantherapeuticaspects,therehastobemorefocusoncreatingcomprehensive

relationshipsbetween childrenand staff, regardlessof the fact that these rela

tional interactionshave to be verbal,orhave a therapeutic content. Trust and

confidentialityhastobecharacteristicfortherelationshipinordertopermitself

disclosurefromthechild,whichcanbetherapeuticallyhelpful.

As

can

be

concluded

from

the

above,

relationships

in

child

welfare

institutions

cover many different areas. Experience with, and research about the COPES


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35

shows that this instrument is valuable in addressing these different aspects of

relationshipsincare.However,afewcommentscanbemadeconcerningtheuse

oftheCOPESwithchildrenandadolescents.Someofthestatementsincludedtoo

difficult languageorcontent foryoungpeople tounderstand,andalso thecon

centrationspanoftheadolescentsmostlywasnotsufficienttostayfocused.No

normativesampleforyoungpeopleisavailable,whichmakesitnecessarytouse

therawscoresforfurtheranalysis.

Still,thisinstrumentcanbesaidtohavealotofadvantagesthatcannotbefound

in other evaluation instruments. First, there are not many instruments to be

found thatassessdifferentaspectsof the social climate in community settings.

Also,thisinstrumentdoesnotonlyincludequestionstoadministerorganisational

factorsbut

it

also

examines

personal

factors

regarding

the

individual,

the

interac

tionbetweenindividualsandpracticalfeatures.Nexttothis,viewsfromchildren

themselvesaswellas fromstaffcanbecollected.Keeping inmindsomeof the

limitationstheCOPEShasforitsusewithchildren;itcanstillbeseenasavaluable

and important instrument forexamining thedeterminantsofprogram climates

andforidentifyingstrengthsandweaknessesinthesocialclimateofaninstitution.


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Listoftables

Table1.TheCOPES:DimensionsandSubscales.

Table2.Overviewoftoolsusedintheresearchproject.

Table3.TheCOPES:RelationshipDimensions.

Table4.StudiesabouttheuseoftheCOPESwithyoungpeopleinresidentialcare.

Table5.DifficultstatementsintheCOPES.


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Listoffigures

Figure1.TheSocialClimateScales.

Figure2.Amodeloftherelationshipbetweenprogramandpersonalfactorsand

residentstabilityandchange.


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the community oriented programs environment scale

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