Public defence: Krisztina Gyüre

Over the past 10-15 years, the share of low-income families with children has increased in Norway and internationally. Low-income families are vulnerable in several ways and need comprehensive support to reduce the consequences of low-income in short and long term. Effective and cost-efficient ways to follow-up this group are of great interest to the public welfare services. The aim of this dissertation is to investigate whether and to what extent comprehensive family follow-up can strengthen low-income families with children and which elements contribute to these changes.

Two areas are of main concern 1. working relationship and 2. parents' labour market participation, including participation in active labour market programs (ALMPs) and paid employment. As a case, I used the model for Holistic follow-up of low-income families (abbreviated as HOLF) and locally developed family interventions, which introduce family coordinators as a new role in the follow-up work in Nav. In the  discussion section, the findings of this ph.d. project are linked to the concepts of complex interventions, active ingredients, program theory and implementation quality. This dissertation consists of four studies: three empirical studies and a research protocol.

Study 1

Study 1 is an RCT study to examine the effects of follow-up with a family coordinator on participation in ALMPs and  employment among parents in low-income families. In the RCT, families were randomized to an intervention and a comparison group, where parents in the intervention group were offered follow-up with a family coordinator, while parents in the control group participated in ordinary follow-up in Nav. The administrative data in the analysis cover a period between October 2015 and December 2018. Results from fixed effects logistic models demonstrate that the effects of follow-up with a family  coordinator (independent of the HOLF-model), on parents’ participation in ALMPs and employment do not differ significantly from the effects of ordinary follow-up in Nav. The assessment of the program effects on a monthly basis indicated favourable effects on activation at the end of the intervention period.

Study 2

In study 2, I focus on parents who participate in ordinary follow-up in Nav, that represent the so-called treatment contrast to the family interventions. The aim of the article was to explore challenges for parents in low-income families and to investigate whether and how they gain access to ALMPs. Some groups are targeted by ALMPs. In study 2, access to ALMPs among 1,681 parents in low-income families in general and in target groups, between October 2016 and December 2018 was examined. The results of random effects models show that parents with reduced work capacity are prioritized to ALMPs. A key finding is that ALMPs are rarely used among parents in low-income families in general. This finding raises the question of whether ALMPs can play a role in the fight against poverty, social exclusion, and the intergenerational transmission of poverty.

Study 3

Study 3 is a research protocol for the HOLF-project, that this ph.d. project is a part of. The protocol is based on two intervention manuals and describes the background and the aims of the HOLF- project, research design, target group, data collection and analysis methods, and ethical considerations. The protocol is a documentation of the planning phase of the project and aims to ensure high reliability. The identification and description of the core elements of the HOLF-model was a key to develop a  program theory and measuring implementation quality in these core elements.

Study 4

In study 4, the elements in the HOLF-model that contribute to strengthen the working relationship with the parents in low-income families were investigated. Working relationship was assessed using the Working Alliance Inventory. The results from paired sample t-tests show that parents rated the working relationship with their family coordinator significantly higher than with the counsellor they had in ordinary follow-up 12 months earlier.

To investigate whether this increase is due to the  introduction of a coordinator or the use of various mapping and follow-up activities, multilevel analysis was applied. The results demonstrate that with a few exceptions, the increase in the working relationship is not associated with the mapping and follow-up activities. A family coordinator with a low caseload and a comprehensive approach seems to be the most  important factor in strengthening the alliance.

The dissertation makes a valuable contribution to the existing body of knowledge regarding the effects and active ingredients of interventions targeting low-income families. To conclude, follow-up with a family coordinator strengthens the working relationship with parents, but has generally no statistically significant effect on the parents' participation in ALMPs and  employment, compared to ordinary follow-up in Nav. The findings of the dissertation are important for developing effective interventions within the field of social work and across various disciplines that involve professionals working with users in need for comprehensive and coordinated services.