Understanding and Supporting Families. with Complex Needs in Italy: An annotated bibliography

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1 Understanding and Supporting Families with Complex Needs in Italy: An annotated bibliography Authors: Elena Cabiati, Francesca Maci, Valentina Calcaterra Project Understanding and Supporting Families with Complex Needs Marie Curie Actions International Research Staff Exchange Scheme

2 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 1 Preface This report is one of a number being published as part of the FP7 Framework, Marie Curie Actions, international researcher exchange scheme entitled Understanding and Supporting Families with Complex Needs. Project partners include academics from the following universities: University of Birmingham (UK) University of Nottingham (UK) Universita Cattolica del Sacro Cuore (Italy) Universitetet i Nordland (Norway) Umea University (Sweden) Universidad Nacional de Cordobe (Argentina) Universidad Catolica de Chile (Chile) Universidad Autonoma de Nueovo Leon (Mexico) Understanding and supporting families with multiple and complex needs is an area of policy and practice that is gaining importance and emphasis across the European Union and beyond. This growing policy interest is mirrored by emergent theoretical and empirical research in various countries. Despite this interest, a recent international research review of approaches to supporting families with complex needs, carried out by Morris, Hughes, Clarke and colleagues (2008) at the University of Birmingham, illustrates a stark paucity of academic analyses of policy and practice concerned specifically with family in relation to a number of service user groups and marginalised communities. That which exists appears fragmented, with little coherency to the international knowledge base regarding current approaches, effective practice or appropriate research methodologies. This project therefore seeks to exploit existing and potential links between divergent disciplines and knowledge streams, both nationally and internationally, to enhance understandings of family-focused approaches across domains of social care, education, and health. In order to do so, three areas of enquiry are underway 1. Theorising families within family support: For family-focused services to deliver effectively, the complexity of family roles, functions, and compositions need to be examined and understood. We will therefore consider how families with complex needs form and experience contemporary life, and how such understandings might inform policy and practice responses. 2. Models and approaches in family- focused policy and practice: There is evidence that existing service provision finds thinking family challenging and controversial. This has implications for professional knowledge and frameworks, and ultimately the arrival at shared objectives. We will therefore explore the models and approaches to family-based service provision evident internationally, and the challenges in implementing such approaches. 3. Researching family-focused policy and practice: Through the sharing of approaches and expertise from various partner universities, we will consider family-centred evaluation methodologies able to: effectively capture outcomes for individual family members and whole families; capture the lived experiences of families; engage families in research; and explore the extent to which services are working together in meeting the needs of a family. The purpose of this report, and the parallel reports exploring other partner countries, is to lay the ground for empirical enquiry into the issues raised above. It highlights existing knowledge through an initial scoping of existing research in this partner country so as to highlight, in a consistent manner, theoretical understandings of family, models and approaches within specific policy and practice, and family-focused evaluation methodologies. It provides a basis upon which researchers will identify case studies to be undertaken during research exchange visits of academics from Europe to Latin America and vice versa. These case studies will be undertaken until the end of 2014, with further publications emerging as a result. Further information on the project can be obtained from the project lead: Dr Nathan Hughes, University of Birmingham, or from the project website: activity/social-policy/families-policy- practice/research/supporting- families.aspx

3 2 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy Research on Family P. Donati, (2007), Famiglie e bisogni sociali: la frontiera delle buone prassi,, (Families and social care: the boundaries of best practice) Angeli, Milan The Annual Report about Family, whose curator is a lecturer of Sociology at the University of Bologna and Scientific Director of the National Observatory about Family, presents interventions and social policies concerning family, both nationally and locally. The first part deals with the issue of transition to adulthood, with the analysis of more recent local legislation about family in Italy in order to evaluate trends, types of welfare in according with an extensive reference to the context Europe. The second part presents case studies of good practice in services and interventions to support families. The final part presents some reflections about the social quality of family welfare and about some proposal for new lines of research and evaluation of services P. Donati (editing by) (2012,) CISF International Center of Family Studies, Twelfth Report, The couple relation today. A challenge for the family, Erickson, Trento The issue of this Report is Being a couple in Italy today. The theme is analysed from a demographic, sociological, psychosocial, psychodynamic and juridical point of view. The Report also contains details of a Cisf research based on a representative sample of Italian couples. The aim is to find out how couples live their intimate relationships and their interchange with the external world, what makes them satisfied with their relation and what are motives for not being satisfied. Moreover the Report aims to put its research in relation with being a family and having children. Highlighting the reasons that make happy or problematic couples daily life, factors emerge creating conflict, and it becomes understandable why the difficulties to establish significant and long lasting relations are increasing. The findings suggest how young and less young couples can be helped to live a relationship which is a resource not only for their personal growth but also for the creation of common good. The Report faces the subject with a humanizing vision of couple relations, in order not to reduce them to merely utilitarian and emotional self satisfaction P. Donati (editing by) (2010), CISF International Center of Family Studies, Eleventh Report, The Cost of Children. Which Welfare for Families amilies, Angeli, Milano The theme of this Report is the cost of children, faced as a cost of the family, not merely in economical terms but in a context of cultural, social and political choices. First the Report draws distinctions between costs of maintenance (basic needs: food, clothes, hygiene, instruction ) and costs of bringing up: the other needs, the dedicated time ). The cost of children is valued here starting from the idea that they are a central value whose cost changes, if considered as a good to invest in, a consumer good, a meritorious or a relational good. Many sustain that in the contemporary society children are not anymore goods to invest in, because of the difficulties and the uncertainties of life and that they become only a consumer good, almost a luxury for those who can permit it: but is it really in this way? Beyond the economical aspects, analysed here in detail, the cost of children emerges above all as a choice of values more than of material sustainability. Understand what is the cost of children makes it understandable how Italian society will change in the coming years and decades. The Report points out which are the implications for social policies and for the model of social State which we can and must wish.. The point is to unmask the hypocrisy of a society that affirms to love children, but is little disposed to pay the costs. We are still far from having a subsidiary society towards families with children. The basic risk is very clear: if Italy does not organise its social welfare system on a children scale, it will go towards a progressive impoverishment considering the ageing of the population and the precariousness of the new generations. P. Donati (editing by)(2007) CISF International Center of Family Studies, Tenth Report, Recognize the Family: Which Surplus Value for the Person and for Society, Edizioni S. Paolo, Milano. In front of urgency to recognize the so called new families, named with different labels (civil unions, cohabitation more uxorio, homosexual cohabitation etc.) and in front of the growing recognition already obtained or obtainable for these forms of aggregation, which are the reasons that still can motivate the support to the family? In other words: why can we still talk about a family which maintains its differences with other social forms that pretend to be called families, or at least, to have the same treatments? Which differences - if existing- can justify the theoretical and practical distinctions, that still let us talk about family instead of civil unions or other? From one side, those who sustain the rights of people that cohabitate to receive equal, similar or analogous recognition as that given to the family, are asked to demonstrate in what these unions are equal, similar or analogous to the family. From the other side those who sustain the specificity of the family have to show - with new reasons- why the family cannot be assembled to other forms of life in common. The answers cannot be easily given. Many think that the problem can be solved in a simple way, giving the title of family to all registered forms of cohabitation. But as this way of solving problems can have a linguistic utility, in the sense that it can be useful in ordinary daily life- just to understand each other- this way does not resist one only minute when defining the concrete rights and duties of the persons that adopt one or another form of life. It is not only a problem of public recognition for example in making use of the benefits of the welfare state. It is also about recognition between private (for example the division of inheritance), and before this it is about an inner and existential problem of the single individual, when he realizes that he does not recognize himself in a personal and familiar identity he believed to have. The Report intends to shine a new light on these aspects, so relevant in our social organisation

4 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 3 Cusinato M., Colesso W. (2010), Economic hardship & family relational resources, Università degli Studi di Padova The aim of the research is verify preliminary findings on relations between economic hardships and family internal and external relational in the North-East of Italy. In addition the study evaluate the impact of social volunteering on families relational. Resources. Findings show that the current economic recession seems to have a negative impact on relational resources in North- East Italian families. Social-Demographic of the Italian Families G. Gesano, F Ongaro, A. Rosina (editing by) (2007), Rapporto sulla popolazione. L Italia all inizio del XXI secolo (Italian Popolation Report. Italy at the beginning of the XXI Century), Il Mulino, Bologna. The report shows the complexity of demographic dynamics in Italy. With a lot of data the report draws a clear and update description of the contemporary Italian society. The main changes presented are: the important number of elderly and the relevant economic and social consequences of these conditions for the future generations; the increasing of immigration, Italy is one of the countries in Europe that has the higher rate of immigration and the fast changes in families. G. Gesano, F. Ongaro, A. Rosina (editing by), Rapporto sulla popolazione. L Italia all inizio del XXI secolo (Report about Population. Italy at the beginning of XXI Century), Il Mulino, Bologna, 2007 The book presents, with large amounts of data, the complexity of population dynamics of contemporary Italian society. The report presents the main changes: the high number of older people, with great social and economic consequences for the future of the society, immigration, whose growth rates are among the highest in Europe, the rapid changes taking place in the family like : cohabitation and civil unions, births outside marriage, separations and divorces. E. Ciccotti, L. Sabbadini, (2007), Come cambia la vita dei bambini. Indagine statistica multiscopo sulle famiglie (Changes in children s lives. A statistic research about families) Quaderni del Centro nazionale di documentazione e analisi per l infanzia e l adolescenza, n. 42, Istituto degli Innocenti, Firenze The Report is the result of the research Elements of a daily life made by ISTAT. The research involved about families, 29,2% with children. Indeed the report presents a specific area about childhood. In the first part there is an analysis about the children s life at home, the first experience of socialization at the nursery, the importance of playing, the pathway toward autonomy and how children spend free time. Furthermore there is a particular attention on the relation between children and new media like internet and mobiles. The second part presents data of the survey that was made. E. Ciccotti, E. Moretti, R. Ricciotti (2007), I numeri Europei (The European Numbers), Quaderni del centro Nazionale di Documentazione e Analisi per l Infanzia e l Adolescenza, Istituto degli Innocenti, Firenze The report shows the data with graphs, statistics and indicators about: population, families, marriages and divorces, births control, education, abortions, mortality and infant mortality, pre-school, suicides, tobacco alcohol and drugs addiction, employment, car accidents.

5 4 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy Family and Community Rossi G. (2007), Capitale sociale e famiglia: riflessioni sociologiche ed esperienze ( Human-social resources and family: sociological reflections and experiences), Nonprofit Review, luglio-settembre 2007,pp The author exposes the necessity to give up the idea of the individualistic-welfare baesd on the autonomy-promotion and selffulfilment to generate capital stock. Instead, it ought to imagine the welfare in relational terms through the diffusion of supportinformal-networks with the consequent establishment of family-communities based on an association-agreement: the self help includes the possibility that give support to another family means that it will be return in own favour. Marta E., Comunità e famiglia (Community and family), Psicologia di comunità, Milano, The report deepens the bond between the family ant the community, giving value to the family-culture in a generative-generation lecture. Rossi G., Carrà Mittini E. (2005), Una ricerca qualitativa sugli organismi di rappresentanza delle famiglie e delle associazioni familiari di Bologna, Trento, Verona e della Regione Lombardia (A qualitative research about Families and Family Associations in Bologna, Trento, Verona and Regione Lombardia,. The research is focused on the capacity of Family Associations to promote active network in the field of local governance. centridiateneo.unicatt.it/famiglia Rossi G., Bramanti D., Meda S., Moscatelli M., (2011), Buone pratiche e servizi alla famiglia (Best practices and family & Community-friendly services), Atheneum Centre for Family Studies and Research, Catholic University of Milan. Analysis and evaluation (through quantitative/qualitative sociological research) of relational best practice in family and community interventions aiming at enhancing social capital during the life span. G. Rossi, L. Boccacin, E. Carrà (2010), Terzo Settore, relazioni sociali e associazioni famigliari nei Servizi alla famiglia (Third Sector, Social Partnerships and Family Associations in Family Services ),, Atheneum Centre for Family Studies and Research, Catholic University of Milan The research explores the development of the role of Third Sector from 2001 to Third Sector takes the form of a strategic actor next to the State, market, family and the informal networks for realizing effective policies for personal families and social wellbeing. Folgheraiter F., Pasini A (2009), Self help groups and social capital: new directions in welfare policies?, in Social work Education, volume 28, issue 3, pp The paper discusses a national survey on social capital arising from self-help/mutual-help groups operating in the field of alcoholrelated problems and affiliated to a large umbrella organization - well known in the Italian welfare system. Comparison between subjects just beginning the group therapy process and those with long-term participation in self-help groups shows significant differences in many aspects of social capital: participation in the local community; proactivity in the social context; family, friends and neighbourhood connections; tolerance of diversity; value placed on life; and work connections. In general, people with longterm experience of self-help groups seem to achieve better scores in social capital than do younger participants, and compared with a significant sample of the Italian (general) population as well. This result seems to indicate that active engagement in their recovery by people experiencing alcohol-related social exclusion may produce impressive improvements not only in their individual quality of life (more health, more trust, more self-esteem) but also in their community inclusion and civic commitment: more social relationships in the family, neighbourhood and at work, participation in civic and voluntary associations, and in educational programmes, including social work education. Pontecorvo C., Arcidiacono F. (2007), Famiglie italiane. Parlare a tavola (Italian families. Speaking around the table)raffaello Cortina, Milano, pp.176 The research is linked to a project since 1991 studies the socialization process in the natural contest durino the family-dinner, chosen as usual moment of meeting. The families involved in the project are middle class and have a standard composition: the parents and at least two children, the minor aged between 3-7 years old. For the research have been used recording, later analyzed with specific instrument (Conversation-analysis and speech-analysis). The report shows the analysis done: the speech as identityconstruction, familiy-roles, narrations, discussion about social value and norms, the education, the speech competence of the children.

6 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 5 Different Forms of Families Ranieri S., Ferrari L., Iafrate R., Bertoni A., Greco O. (2010), Genitorialità in diverse forme (Parenthood in different family forms),, Università Cattolica di Milano, Milano The theoretical framework of the research: parenthood is interwoven within the family relational network: the couple s relationship, the relationship with the partner s parents and the social context affect parenting; specificity of maternal and paternal parenthood; shared parental responsibility and social dimension of parenthood. Lelleri R., Prati G., Pietrantoni L. (2008), Omogenitorialità: i risultati di una ricerca italiana (Homo-chilhood: findings of an italian research),, in Difesa Sociale, n. 4 The parenthood of the homosexual person is become a discussed topic in the public arena on the psychological and juridical plan. The phenomenon has undoubted implications on the social work plan and the educational interventions. The results of the research show that in Italy childhood involved 5% of the homosexual population, both female and male, is diffused all over the territory and concern children conceived in heterosexual couples. Belletti F., Boffi P., Pennati A. ( 2007), Convivenze all italiana. Motivazioni, caratteristiche e vita quotidiana delle coppie di fatto (Common law-marriage. Reasons, characteristics s and daily-life ), Paoline,Milano,pp.167 The authors carried out a qualitative research focused on the phenomenon common law-marriage, by deep interviews to 120 couples, realized in 6 different Italian regions, in order to listen and describe the opinions conducting this choice, the internal dynamics of the relation, the social implication and overall to test the existent of an alternative family project. The stories collected show the common law marriage choice as a transition and the aim s way remain the marriage. Family Policies Donati P.P. (edit by), Il costo dei figli. Quale welfare per le famiglie? (The cost of chidren. Which kind of welfare for the families?) The XI Cisf Family Report is focused on the cost of children considered not only in economics terms but in a framework of cultural, social and politics choices. The cost of the children is considered as a value because represents an investment on the future which produce relational goods. The report shows which is the impact on social policies and on the desirable model of Welfare State. This original study will be repeat every two years on a representative sample of Italian families. Caritas Italiana, Fondazione Zancan, (edit by) (2009), Famiglie in salita. Rapporto 2009 su povertà ed esclusione sociale in Italia ( Families rising. Report 2009 on poverty and social esclusion in Italy), Il Mulino, Bologna, pp.292 This nine report explore new economic difficulties of italian society based on actual economic crise which involved a lot of countries with advanced economies. The work is divided in two part: the first one points out how different regional welfare systems try to cope with poverty. The second part is focused on the link between the Church and poverty: are presented the results about 372 Charity Centers. The study shows in particular the reality of 8 regions considered as case-studies (Lombardy, Veneto, Tuscany, Campania, Apuglia, Basilicata, Calabria and Sicily). Donati P. and Prandini R. (editing by) (2008), La cura della famiglia e il mondo del lavoro. Un piano di politiche familiari (The care of family and the work world. A plane for family policies), Angeli, Milano The two editors, who are both Sociology professor at Bologna University, collected the researches realized by National Family Observatory, settled in Bologna, focused on the theme of conciliation between professional work and family care in UE guide lines framework which set the European Alliance for families. After a first general definition of the question, the work present the Italian case related to international context. Finally is designed for the first time a possible scheme of Family Policies National Plan.

7 6 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy Donati P., (2010), Piani nazionali e politiche familiari: sfide ed opportunità per l Italia (National Plans and Family Policies: Challenges and Opportunities for Italy), European Congress of Family Policies in Europe: best practices, partnership and governance Europe is experiencing a revolution in family structures and behavior which Donati terms the morphogenesis of the family. Social policies struggle to keep up with these changes since the trend to take patterns form the past as their reference or follow spontaneous evolutionary changes. The report compares Italian and European family policies. After a presentation of the family conditions, the author underlines weakness and challenges of family policies. Donati P. (2004), The fundamental principles of family policy: rethinking the rights of the family in a Society undergoing globalization, paper of the meeting of the Social Trends Institute, Roma Changes of the family become a challenge for social policies, which, without an adequate family policy, misses the mark completely. To face the new challenges, most of the welfare regimes adopt a mix-up of lib-lab principles. Caritas Ambrosiana e Fondazione Zancan (2010), X Rapporto su povertà ed esclusione sociale in Italia (10 Report on Poverty and Social esclusion in Italy), Milano The Report is divided in two part. The first one, edited by Zancan Foundation, take into account the territorial dimension of poverty and the capacity of regions to solve the problem, look at some European Countries. The second part, edited by the Charity organization Caritas Italy, analyze the consequences of economic crisis on family. It is also describe the actions of different National Caritas in Europe related to Zero poverty Program promoted by Caritas Europe for the 2010 th. Family-Work Reconciliation Rossi G., Mazzuchelli S., Bosoni L., Bramanti D. (2011), Best practices and Family-Work Reconciliation, Milano The study focus on : transformations in life and identity of both men and women, transformation in the labour market, Family and Work Reconciliation. The draw-research is based on the following steps: Analysis, Evaluation and Intervention (through quantitative/qualitative sociological research) of relational best practices in the Corporate Welfare aiming at enhancing social capital during the life span. Main Research Projects: Best Practices of Company Welfare, Men, work and family life: a comparison of men`s work/family reconciliations in the UK and Italy (in collaboration with the Oxford Brookes University), Family and Work Reconciliation Good Corporate Welfare Practices (national research project). Website: centridiateneo.unicatt.it/famiglia

8 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 7 Immigration in Italy P. Attanasio, F. Pittau, A. Ricci (IDOS Centre of Study and Research) (2010 ) Temporary and circular migration: empirical evidence, current policy practice and future options in Italy, in partnership with the Caritas/ Migrantes Dossier Statistico Immigrazione, Rome The main objective of this study is providing a contribution to the systematic analysis currently in use in Italy using as a guideline the concept of circular migration as defined by the European Commission. The introductory paragraph highlights that the study objective is principally illustrating the evolution of the concept of circular migration in the context of international and European organizations, which is obviously not referred to the recent developments in the Italian context. As a complement to this institutional development, reference is made to the investigations conducted by experts, mostly in areas of research connected with the EU and international structures. In the following paragraph the temporary and circular migration approaches that have been dealt within the Italian context are illustrated, with clear evidence of what has been done in the area of legislation, in bilateral cooperation with Third Countries and finally showing the actual implementation of those perspectives found in some pilot projects. The last paragraph, which is based on the achievements of the previous ones, develops a series of sociological and employment reflections (allowing the harmonization of the basic feelings) as well as legal and political reflections (which open the perspective of what can be done practically). F. Pittau, A. Ricci, G. Urso (2009), Projects and strategies in Italy fostering assisted return and re-integration in third countries, IDOS Study and Research Centre, Rome. Starting with the 90 s, due to its particular geographic position in the centre of the Mediterranean routes, Italy faces a continuous increase of immigrant population, maintaining in the same time a strong irregular dimension, related to different factors concerning norms and customs. Since then, strict measures of control and counteracting the irregular flows are introduced as one of the basic elements of the migration policy, and in the same time special procedures of voluntary accompaniment in the country of origin are envisaged. In the Italian case, the strong migration pressure faced by Italy during the past few years orientated the legislative actions towards a stronger border control, as it can be noticed in the migration policy. The study approaches the return in its both forms, forced return and voluntary return, making constant references at today literature on the topic, aiming to provide - at national and European level - for politicians, researchers, social workers and for the migrants themselves and migrants associations as well - the necessary instruments to analyze the Italian experience. The study focuses especially on the second form of return, the assisted voluntary return, accessible only for some categories of migrants: trafficking victims and humanitarian cases, migrants for humanitarian emergencies and asylum, unaccompanied minors. The study, as its structure shows, aims to examine all the dimensions related to the phenomenon (statistic, demographic, social, politic and juridical ones) which was given importance in public debates as well. C. Regalia, C. Giuliani, M. L. Gennari, C. Manzi, M. Lanz, C. Gozzoli, M. Brambilla, O. Greco, (2010) Family, immigration, and culture, Università Cattolica di Milano. The studies: Family life space of immigrant couplet, Immigrant women in Lombardy, Family relationships with grandparents, identity and personal well-being in second-generation teenagers, Immigrant couples and encounters among cultures. The aims: investigating the way immigrant couples can live their familiar and social space after the immigration, unveiling the psychological and relational processes which are likely to enhance a positive or critical relation with own family culture and host culture. Methods: qualitative research ( Interview + Couple Life Space ) 100 immigrant couples from Morocco, Brasil, Philippines,Ghana. F. Pizzi, (2008), I nuovi cittadini: le famiglie dei migranti (New citizens. The migrant families), in La Famiglia, n. 244, pp The article analyzes migrant families whereas in Italy the perception of immigrant people is changing: before they were considered just as host workers, today as single members of a family. The article presents a brief review of the contemporary research about migrant families, the author analyzes the subject in relation to the Italian situation. Then he discusses about the idea of a multidimensional and democratic citizenship in according with the idea that each people has about the nation. At the end he discusses about which is the way to integrate new citizens. Istat (2007) La popolazione straniera residente in Italia al 1 gennaio 2007 (The foreign people that live in Italy at January 1th, 2007) ISTAT, Roma The ISTAT report shows summary statistics for the year 2006 compared to the immigration in Italy, the birthrate, the areas of origin of immigrated people, the geographical distribution. In the report there is a particular study about the birth and fertility of foreign women living in Italy.

9 8 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy M. Simoni, G. Zucca, ( ), L esperienza migratoria matura. Un indagine sui processi d integrazione sociale delle famiglie immigrate in Italia.. (The experience of immigration. A study about social inclusion processes of immigrant families in Italy), in Relazioni solidali, n. 5 pp The thesis of this research is that an immigration project is complete when the whole family is immigrated. A second thesis is that is the family that make possible and improve inclusion instead of single people. The research studies the processes of inclusion and socialization, by analyzing the migration process, relations with the Italian society and the community s ethnic, employment status and pattern of consumption and savings. M. Simoni, G. Zucca (editing by) (2007) Famiglie migranti. Primo rapporto nazionale sui processi d integrazione sociale delle famiglie immigrate in Italia (Immigrant families. Firs national report about processes of social inclusion of immigrant families in Italy) Franco Angeli, Milano, pp The study is sponsored by Patronato Acli Nazionale and it is realized by Istituto di Ricerche Educative e Formative (IREF) (Educational and Training Reseach Institute). The research aims to draw a general picture of the stabilization processes of immigrant families in Italy. It addresses the following topics among others: the migrants as social capital, the role of secondgeneration immigrants, the relationship between immigrants and the labor market and the different aspects of citizenship also economic, the reaction of Italian society to the challenge of integration. In attached you can find the questionnaire that was used with the sample of research. Families and Divorse L. Todesco, (2009) Matrimoni a tempo determinato. L instabilità coniugale nell Italia contemporanea (Marriage with a fixed-term. The instability of marriages in the contemporary Italy) Carocci, Roma, pp. 189 In Italy the instability of marriage is a common phenomenon, although it does not reach the levels that are present in many other European countries. With a quantitative analysis on empirical data, the author proposes a sociological perspective that take account the element of gender. The research starts from the causes and suggests a reflection on how this phenomenon is increasing, and then thinks about the most important consequences. In particular the research considers two of these: the unequal economic future situation of husbands and wives, following the failure of the marriage, and the difficult reconstruction of the relationship among fathers and sons witch don t live together.

10 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 9 Families and Elderly G. Costa (2007), Quando qualcuno dipende da te. Per una sociologia della cura (When someone needs your help. For a sociology of care), Carocci, Roma, pp. 197 The book presents, from an empirical research, which kinds of reorganization are necessary when an adult member of a family needs important care because of loss of his autonomy. This is a critical situation that requires a more or less radical revision of the habits that govern daily life. The research shows how the needs arising from these situations have a strong destabilizing pressure on family structures that would otherwise be solid. The theoretical framework proposed is that of social vulnerability, increased by weakening of the main mechanisms of social integration and by the increasing difficulties to access to welfare support. The connections between the needs of care, their impact on daily life and the strategies put in place, yet little studied, are analyzed from the perspective of those providing care. Donatella Bramanti and Elisabetta Carrà (edit by) (2011), Buone pratiche nei servizi alla famiglia. Famiglie fragili e famiglie con anziani non autosufficienti (Good practices in the family s services. Vulnerable families and families with elderly person who are not self-sufficient), Osservatorio Nazionale sulla Famiglia, Milano The research focus on the topic Supporting the elderly person with a family friendly perspective. The study is developed on several levels: data analysis about older, long-term care, state of health, financial straits, services supplied; data retrieval about Charities providing services for the elderly person and the care givers; new practises and form of intervention to support the elderly person in the families; re-call (through phone-interview) about the practices almost used to evaluate the performance and the -resistance during the timeperiod; case-studies about good practices. The results show that it s important to promote synergies among the welfare actors. The cases analyzed highlight the relational and united boost in the communities, the self-help and the familiy-experiences engaged in the care. M. Di Rosa, M. Melchiorre, M. Lucchetti, G. Lamura (2012), L impatto delle assistenti familiari straniere nel settore della cura agli anziani: tendenze recenti ed evidenze empiriche in Italia (The impact of migrant work in the elder care sector: recent trends and empirical evidence in Italy) Italy is characterized by a very high and increasing demand for elder care but, paradoxically, also by a surprisingly low level of public service provision in this sector. Due to current demographic, economic and socio-cultural trends, the potential availability of informal care has been decreasing while, on the other hand, still strong familistic attitudes have so far limited the emergence of formal-both home and residential-care services. The cash for care orientation of the Italian welfare system, with direct payments prevailing over in-kind services, has thus gradually developed into a care regime where monetary transfers to dependent (older) people are often used to privately employ migrant care workers. This phenomenon is analyzed in the context of two different studies in order to understand how migrant care work has been affecting both family care and professional care work in Italy. The main findings suggest that the widespread employment of migrant care workers-propelled by public care allowances-has certainly relieved many families from most burdensome care tasks, but at the same time partly crowded out formal care services. Care quality issues remain, however, largely under-investigated, as do care drain effects in sending countries. G. Nesti, S. Campostrini, S. Garbin, P.Piva, P. Di Santo, F. Tunzi (2003),, Providing integrated health and social care for older persons in Italy, Procare, Rome In Italy the problem of integrated health and social care exists since the national health system was eventually given birth in 1978 thus overcoming the old corporatist system with assistance assigned to the mutualistic agencies of the various professional categories. The foundation of a health system on a universal basis (L. 833/1978), however, was not able to trigger an equally strong impact on the development of social services. In this contribution the authors tried to shed light on the growing importance of health and social integration for older persons and respective developments in Italy between 1980s and 1990s. Improvements have developed in a differentiated way and with significant regional variations. Main impediments to the diffusion of a generally integrated approach to the provision of social and health services for older persons in Italy consist in the following aspects: There is not one single legal framework concerning integrated health and social care at the national level, but health and social matters are regulated by separated legislation. This distinctions also reflected on the regional and local level, thus increasing the complexity of any coordination efforts between the two sectors. This structural complexity can be observed both at the vertical and at the horizontal level in the first case this is concerning federal and regional policy-making (legislation), at the horizontal level the distinct organization between health and social services is crucial. National legislation only defines guidelines for the development of integrated health and social care, it describes some basic services

11 10 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy that should be present in every region, and defines an organizational framework, but it also delegates the detailed planning of services and activities and the definition of the care network to regional institutions. As we have seen above, this has fostered a strong differentiation in local supply, the creation of territorial divides, which has been harmful to the principle of equal treatment of all citizens. Moreover, this fragmentation hampers the process of mutual learning among regions, and between regions and national institutions, in particular with respect to the promotion of effective organizational and managerial models. Finally, there are variations between regions in terms of economic resources, local culture, and attitudes of public administration towards innovation. There are no economic strategies and mechanisms to improve integration between health care, which represents by far the richer sector, and social care. The cultural and professional deep divide between health and social care systems can be observed both between professionals engaged in care provision but also between health care-management and social care management. The reform law n. 328/2000 was to give an answer to all these cultural, financial, and organizational unbalances and thus formulated the strategic objective already in its title: Framework law for an integrated system of interventions and social services. The principles introduced by the reform are very ambitious: Universalism, The quota of essential services, A national fund to rebalance, the social zone, the Horizontal Subsidiarity. Families and Disability Bertelli M., Bianco A., Rossi M., Scuticchio D., Brown I. (2011), Relazione tra la qualità di vita individuale e quella famigliare per persone affette da disabilità psichica che vivono in Italia,, (Relationship between individual quality of life and family quality of life for people with intellectual disability living in Italy),, CREA - AMG Centre for Research and Evolution-, Firenze There is substantial literature investigating quality of life (QoL) of individuals with intellectual disability (ID). QoL of families of people with ID is emerging as an important field of research. Despite this, there is a lack of studies regarding their relationship. Aim: the present paper aimed to study the relationship between QoL scores of individuals with ID and members of their families. Methods: twenty-seven parents or relatives of 27 adults with ID were recruited by four different research centres across Tuscany (Italy) to be interviewed through the Italian adaptation of the Family Quality of Life Survey (FQoLS-2006), a tool developed for use in a multiple-country study on family QoL. The FQoLS-2006 was translated and adapted to Italian through three revisions. The last was submitted to the authors of the original version, who also maintain an electronic data file and data archive for statistical evaluations in various countries. QoL of persons with ID was assessed through the administration of the Quality of Life - Instrument Package. QoL scores were analysed to describe population characteristics and to examine the relationships among measures of individual and family QoL using correlations (Pearson and Spearman). Results: findings showed that family ratings of QoL were generally low. Families interviewed reported a low level of QoL in Support from Others and Community Interaction, while Family Relationships and Health of the Family rated higher. For individual QoL, individuals had the lowest scores in the area of Spiritual being and higher scores in the area of Physical being. Correlations examining possible relationships among Importance, Satisfaction and Opportunities found some statistically significant correlation coefficients between some aspects of the three main areas of individual QoL (Being, Belonging and Becoming) and the nine family domains. Most of these correlations regarded family Financial Well-Being, Family Relationships, Support from Service and Support from Others areas. Conclusions: the results of this study suggest that QoL is perceived somewhat differently by individuals with ID and by members of their families. This difference could negatively impact QoL of people with ID, if their views are not taken into account when planning for family support. The relationships between individual and family QoL appear to be quite complex, and such complexity needs to be clarified in future research.

12 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 11 Bertoli M, Biasini G, Calignano MT, Celani G, De Grossi G, Digilio MC, Fermariello CC, Loffredo G, Luchino F, Marchese A, Mazotti S, Menghi B, Razzano C, Tiano C, Zambon Hobart A, Zampino G, Zuccalà G., Bisogni e sfide di vita quotidiana per le persone affette da sindrome di down (Needs and challenges of daily life for people with Down syndrome),, Rome, Population-based surveys on the quality of life of people with Down syndrome (DS) are difficult to perform because of ethical and legal policies regarding privacy and confidential information, but they are essential for service planning. Little is known about the sample size and variability of quality of life of people with DS living in the city of Rome, which has a population of 2.7 million inhabitants. The aim of the present study is to explore the needs and challenges in health, social integration and daily life, of people with DS living in Rome. Methodology: a cross-sectional, census-based survey was conducted in All family doctors (3016 in total) of the National Health Service were involved by the Statistical Bureau of the Municipality of Rome. As per the census, every resident citizen is registered with a family doctor and every person with disabilities is coded. Associations for Down Syndrome encouraged their members to participate in the research. Questionnaires were completed by families of people with DS, in accordance with privacy laws. Findings: an initial survey, conducted via a letter and a telephone contact with family doctors, identified 884 people with DS residing in the city of Rome. Data on the medical and social conditions of 518 people with DS, ranging in age from 0 to 64 years, were collected. Some 88% of these were living with their original family; 82.1% had one or more siblings, and 19.5% had lost one or both parents. A full 100% of children with DS were enrolled in the public school system. This ensures that they are fully occupied and entirely integrated in society. After secondary school there is a lack of opportunities. Thus, only 10% of adults were working with a regular contract. A mere 42.2% of people with DS aged were involved in some form of regular activity (although not always on a daily basis). After the age of 30, the percentage of people demonstrating decline in function increased sharply, while disability-related support decreased. In other words, as people with DS age, daily life evolves increasingly around the home, with only occasional outdoor activities. Conclusion: the health, employment and social needs of the majority of people with DS in the city of Rome are not being met. The findings of this study underscore the urgent need for more comprehensive inclusion in society of adults with DS and for the provision of support services to create an enabling environment for inclusion. Because of the variability of performance among individuals with DS, there is a need to create more case-specific options in terms of work, living arrangements, social networking and medical services. Schooling and social inclusion in childhood alone do not guarantee a satisfactory quality of life in adulthood. It is argued herewith that policy of inclusion and support should extend over the entire lifetime of people with DS. Families and Mentha Health De Girolamo G., Bassi M., Neri G., Ruggeri M., SantoneG., Picardi A. (2007), Lo stato attuale della cura della malattia mentale in Italia: problemi, prospettivi e lezioni da imparare (The current state of mental health care in Italy: problems, perspectives, and lessons to learn,, European Archives of Psychiatry and Clinical Neuroscience special issue, published online After legislative changes in 1978, Italian psychiatry underwent a thorough overhaul, with the gradual closure of all Mental Hospitals. A nation-wide network of Departments of Mental Health now deliver outpatient and inpatient care, but also run semiresidential and residential facilities (the latter with 2.9 beds per 10,000 inhabitants). Hospital care is delivered through small psychiatric units (with no more than 15 beds). There are also many private inpatient facilities operating in Italy, and the number of private inpatient beds per 10,000 inhabitants exceeds the number of public beds; overall there are 1.7 acute beds per 10,000 inhabitants - one of Europe s currently lowest numbers. There is marked quanti- and qualitative variation in the provision of out- and inpatient care throughout the country, and service utilization patterns are similarly uneven. Studies examining quality of life report a fairly high degree of patient satisfaction, whereas patients families frequently bear a heavy burden. In conclusion, the Italian reform law led to the establishment of a broad network of facilities to meet diverse care needs. Further efforts are required to improve quality of care and to develop a more effectively integrated system. Greater attention must be paid to topics such as quality of care and outcomes, public and private sector balance, and the coordination of various resources and agencies.

13 12 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy L. Magliano, C. Marasco, A. Fiorillo, C. Malangone, M. Guarneri,M. Maj (2002), L impatto delle reti di support professionali e sociali sul carico delle famiglie di pazienti affetti da schizzofrenia,, (The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy), the Working Group of the Italian National Study on Families of Persons with Schizophrenia, Napoli, 2002 Objective: to explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and to test whether a higher level of family burden is associated with a lower level of professional and social network support. Method used: seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients clinical status and levels of disability; (b) relatives burden, social and professional support; (c) interventions received by patients and their families. Results: family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. Conclusion:professional and social network support represent crucial resources to reduce family burden in schizophrenia. Pycha R, Giupponi G, Schwitzer J, Duffy D, Conca A (2011), La riforma della psichiatria in Italia del 1978: pietre miliari per l Italia e l Europa nel 2010?,, (Italian psychiatric reform 1978: milestones for Italy and Europe in 2010?),, Psychiatric Service of Bruneck (BZ), The Italian psychiatric reform of 1978 was one of the most radical attempts in history to abolish the practise of custodial psychiatry using legislation. The work of the charismatic reformer Franco Basaglia had four main objectives, which have taken more than 30 years to achieve. Although the creation of outpatient mental health centres and a reduction in involuntary commitments occurred rapidly, the expensive development of small acute psychiatric departments in general hospitals as an alternative to psychiatric hospitals was implemented very slowly. According to a national survey by the Italian Ministry of Health, in 2001, there were a total of 9,300 acute beds for all of Italy, of which as many as 4,000 were in private facilities. With 1.72 acute beds per 10,000 inhabitants, Italy has one of the lowest figures in Europe of psychiatric beds. However, Italy s apparent and often praised low bed requirement places a large burden on families. The implementation of the reform process was most delayed and occurred at its worst in South Tyrol, in North Italy. In an effort to achieve a modern and progressive community-based psychiatric service, in particular one with more specialised services, mental health providers in this region have examined German, Austrian and Swiss models of psychiatric practice.

14 Understanding and Supporting Families with Complex Needs in Italy: A review of research and policy 13 Families and Drug Addictions Arcidiacono C., et al. (2009), Famiglie sotto stress.. Con-vivere con persone dipendenti da droga e alcol (Families under stress. Co- habit with drug and alcohol-addiction), Unicopli, Milano, pp. 246 The volume describes the resources and the difficulties of the family s member (parents, children, wives, sisters) living with a person who abuse drugs, recurring to coping-strategies based on control and avoidance. Cancrini, L., Cingolani, S., Compagnoni, F., Costantini, D. and Mazzoni. S. (1988), Consumo giovanile di droga: una tipologia di dipendenti da eroina e le loro famiglie,, (Juvenile Drug Addiction: A Typology of Heroin Addicts and Their Families)-Family Process Review In this article the authors propose: 1) a typology of drug addiction cases consisting of four main classes: A. traumatic drug addiction, B. drug addiction from actual neuroses, C. transitional drug addiction, and D. sociopathic drug addiction; 2) a clinical study (with 18 months of follow-up data) involving 131 heroin addicts mostly treated with structural or counter-paradoxical family therapy in the same psychotherapy center and in the same year; and 3) some preliminary conclusions emerging from an examination of the four-class typology with respect to the effectiveness of family therapy interventions. If, for example, structural family therapy techniques seem more suitable in type-b cases (similar to cases described by Haley in his Leaving Home), the counter paradoxical techniques are likely to be more effective in type-c cases (similar to the anorectics described by Selvini- Palazoli. Child Protection Ciampa A., Ciccotti E., Salvi A., Breschi S., Moretti E. (2004),, Ogni bambino ha diritto ad una famiglia: lo stato di attuazione della L 149/2001 (Every child has the right of a family: the state of implementation of the 149/01 law, Quaderno n.33 del centro di documentazione e analisi per l infanzia e l adolescenza, Istituto degli Innocenti I bambini e gli adolescenti negli istituti per i minori, Firenze The aims of research are basically four: a) develop an updated mapping of institutions for children throughout the country, so as to highlight and the number also the geographic location; b) detecting the elements qualifying institutions for children, in particular regarding the size (structural and operational) and try to check the life context in which the child is placed during his stay; c) provide a framework that shows qualitative and quantitative aspects characterizing the living conditions of children guests of this type of residential care facilities and allow a reliable quantification, as well as to assess the need reception and identify and design appropriate strategies effective and able to provide consistent answers to their needs; d) assess what is today the state of implementation of the law 184/1983 (child protection act) in relation to the specific area of activity of communities for children, and appreciate the actions of reorganization previously fielded to fulfill the conversion process and, ultimately, de-institutionalization precisely as required by law. Donatella Bramanti and Elisabetta Carrà (edit by) (2011), Buone pratiche nei servizi alla famiglia. Famiglie fragili e famiglie con anziani non autosufficienti (Good practices in the family s services. Vulnerable families and families with elderly person who are not self-sufficient),, Osservatorio Nazionale sulla Famiglia, Milano The research group works on the issue of fragile families with children. The study has focused in particular on three areas of interest: families with children in protection or at risk of removal; families where parents are separated / divorced; migrant families. In geographical terms, the research on fragile families with children has focused on two regions with similar social and territorial features, but with very different social policies: Lombardy and Piemonte. The area of the fragility of families with children is very multifaceted and intersections complex. If you add this to what emerged from the deepening family association, you could say that in front of a fragile family emerges paradoxically increasing robustness of the traditional family: firm and clear mediating role between genders and generations that it is able to express becomes an invaluable resource today to counter the weakening of families: families that save families.

15 Institute for Applied Social Studies University of Birmingham Edgbaston, Birmingham B15 2TT, United Kingdom

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