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Effectiviteit van de jeugdzorg: passen en meten

The effectiveness of youth care: getting the right fit

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Kind en adolescent

Samenvatting

Bij het bepalen van de effectiviteit van zorg heeft de nadruk zeer sterk gelegen op de zogenaamde ‘evidence based practice’ (EBP), waarbij het vaak ging over ‘bewezen effectieve behandelingen’. Wat echter steeds bleek: de behandelingen verschillen van elkaar, maar ze lijken heel sterk op elkaar wat betreft hun resultaten. Om het vraagstuk van het verbeteren van de effectiviteit op te lossen, zullen niet alleen de specifiek werkzame elementen of technieken van de interventies in kaart moeten worden gebracht, maar ook de algemeen werkzame factoren. Eén daarvan wordt in de literatuur vooral veel als belangrijke factor genoemd: de alliantie (de werkrelatie tussen therapeut en cliënt). Het voorgaande betekent dat we de interventies en EBP minder als uitgangspunten moeten nemen voor effectiviteit van de zorg, maar veel meer nadruk moeten leggen op de individuele cliënt en gepersonaliseerde zorg. Een cruciale rol is daarin weggelegd voor het voor en tijdens de behandeling meten van de afname van de problemen en de kwaliteit van de alliantie, en voor het benutten van deze data. Dit kan via feedbacksystemen (Feedback Informed Treatment, FIT). Uiteindelijk heeft de gepersonaliseerde zorg de potentie om de jeugdzorg te optimaliseren.

Abstract

The past two decades have witnessed an increased emphasis on evidence-based treatments as the best way of providing effective care. More recently, in view of the finding that differences between treatments only have a marginal effect on treatment outcomes, techniques or common elements have been assumed to be more predictive for outcomes. At the same time it has been established that common factors, especially the therapeutic alliance, predict treatment outcomes. All of these findings suggest that if we want to improve youth care, we should opt for practice-based evidence instead of evidence-based practice. More specifically, youth care can benefit from Feedback Informed Treatment (FIT), a data-based approach in which different types of data on each individual client are gathered and used in treatment. As such, FIT will enhance personalized treatment, i.e. treatment that focuses on individual clients, applying information about the individual client (e.g. diagnoses and demands), the treatment (e. g. alliance and common elements), and the context (e. g. the quality of the care offered). Ultimately, personalized treatment has the potential to optimize youth care.

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Correspondence to Ron Scholte.

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Dit artikel is een bewerking van de inaugurele rede van prof. dr. Ron Scholte, uitgesproken aan de Radboud Universiteit op 16 december 2016.

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Scholte, R. Effectiviteit van de jeugdzorg: passen en meten. Kind Adolesc 38, 91–107 (2017). https://doi.org/10.1007/s12453-017-0141-z

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