Effective practice to
protect children living in
highly resistant families
Lorraine Hansom, Sector Specialist
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Aims & Objectives
• To explore key messages from national
research & learning from local reviews
• Develop working awareness & understanding
• Develop skills & confidence in making decisions
and achieving change
• Understand staff care & safety issues
• Consultation on SSCB practice guidance
• For parents & children to more readily engage
in interventions to change entrenched behaviour
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Why is this important?
• Recent high profile child protection cases have
raised concerns about some extremely
‘resistant’ families who do not change despite
intervention
• Research and practice suggest that most
parents who maltreat their children do not fall
into this group
• There is a need to better understand resistance
and how these families can be helped
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Local Evidence
• Serious case review NS10
Working with hostile or highly resistant families can deflect
social workers and other professionals from focussing
upon the needs of children in such families
• Learning review
5 agencies 34 families 44% inadequate safeguarding arrangements
These families present resistance early within universal
services. Lack of engagement / take up of support usually
leads to closure / discharge = a missed opportunity to
intervene early
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C4EO Evidence base
• Safeguarding Knowledge Review 1 “Effective Practice
to protect children living in “highly resistant” families”
• Safeguarding briefing 1 “Effective Interventions for
complex families where there are concerns about, or
evidence of, a child suffering significant harm”
• Safeguarding briefing 2 “What are the key questions for
audit of child protection systems and decision-making?”
• Safeguarding briefing 3 “The oversight and review of
cases in the light of changing circumstances and new
information: how do people respond to new (and
challenging) information?”
• These can all be downloaded from www.c4eo.org.uk
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Knowledge Review
1. What are the circumstances, characteristics
and prevalence of families that are resistant to
change?
2. What challenges to practice do resistance, and
the underlying characteristics and
circumstances, raise?
3. What services, treatments and interventions
are effective for families that are resistant to
change?
Rebecca Fauth, Helena Jelicic, Diane Hart and Sheryl Burton,NCB
Professor David Shemmings,University of Kent
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The review evidence base
• ‘Highly resistant’ families are a subpopulation that
does not get much specific attention in research
• Thus, we mined existing literature on:
– families with ‘multiple’ or ‘complex’ problems
– maltreatment recurrence
– serious case reviews
– practitioners’ and parents’ perceptions of
effectiveness
• Used this literature to infer relevant information
about the most challenging families.
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What is resistance?
Ambivalence
Denial/Avoidance
Unresponsiveness
to treatment
Violence/Hostility
(Confrontation)
(Disguised Compliance)
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Prevalence
• No evidence on prevalence of ‘highly resistant’
families per se
• Recurrence rates vary significantly between
studies due to differences in study design (i.e.,
25-69 per cent)
• 2005-2007 analysis of serious case reviews
revealed that 75 per cent of families were
characterised as ‘uncooperative’, which
included hostility, avoidance, disguised
compliance and/or ambivalence.
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Exercise
Think about the ‘reluctant’ families with whom you
are working where it is hard to achieve change
• Precisely what was the behaviour that made
you think they were reluctant / resistant?
• When did it happen?
• Why do you think it happened?
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Circumstances and characteristics
Beware! These are associations.
They are not causes and nor are they reliable indicators
Key circumstances associated with recurrence:
• Families’ history of abuse, particularly substantiated and
repeated prior reports, one of the most consistent and
strongest factors
– Possibility of labelling and further scrutiny of these
families?
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Circumstances and characteristics
• Multiple, simultaneous problems
– Domestic violence, substance misuse, mental health
problems in combination are a stronger predictor of
recurrence than each alone
– Criminal activity, lack of financial resources, low
social support
• Lack of timely services and assessments
• Child characteristics associated with being hard to help:
premature, disabled, teenagers, those returning home
from care
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Parental attitudes
• US study using parent-reported and observed
parent-child interactions found that abusive
parents’ reports of their children’s behaviours
were more negative than that observed by the
researchers
– Suggests the need for more observations of
parent-child interactions
– Many studies do not differentiate between
mothers and fathers; indeed ‘parenting’ is used
when focus is solely on mothers.
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Implications
Difficult to describe ‘highly resistant’ families when
the term is not specifically used in the research
evidence base
It is unlikely that a ‘checklist’ of key indicators of
resistance can be created
There is an urgent need to progress beyond simple
correlational research (i.e. is parent substance
misuse associated with recurrence?) to enable
assessment about processes (i.e. why and in what
circumstances is substance misuse related to
recurrence?)
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Barriers faced by families
• Fear of consequences
• Stigma and mistrust
• Actual experience of receiving services
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Fear of consequences
• Parents who are aware that behaviours are
damaging but are reluctant to give them up will
conceal difficulties, e.g.
– Addiction
– Relationships with perpetrators
• Parents who fear that their children will be taken
away from them will minimise issues e.g.
– Domestic violence
– Mental ill health
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Stigma and Mistrust
• Parents who are discriminated against e.g.
– Black and Ethnic Minority groups
– Disabled parents
• Communities who consider it stigmatising to seek state
help
• People who have experienced coercive state power in
the past
• Parents who hold strong views about physical
punishment or child compliance
• Parents who appear to be coping well but have low
tolerance of stress
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Experience of services
• Parents who were in care themselves
• Parents whose earlier experience of
receiving services has involved:
– Services which they didn’t find helpful
– Power being taken from them
• Workers being judgemental, rude, not
understanding
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2. What challenges to practice do
resistance, and the underlying
characteristics and circumstances,
raise?
Challenges relating to families
Challenges relating to practitioners
Challenges related to agencies
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Challenges related to families
• Practitioners are able to describe behaviours
and circumstances that pose challenges to their
practice including:
– Inability to contact parents
– Families’ lack of motivation/commitment
– Families that are in constant crisis
– Violence
• But, they lacked confidence distinguishing between
families’ active engagement in treatment vs. false
compliance.
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Challenges related to practitioners
• When working with complex families, practitioners
sometimes become overly optimistic
– Focus too much on small improvements rather than
considering families’ full histories
• Practitioners need to ensure they:
– Are willing to make critical judgements
– Do not underestimate harm to children
– Do not develop ‘fixed views’ of families that are not
updated in light of contrary evidence
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Challenges related to practitioners
• Practitioners involved in complex cases may lose
focus on children when:
– Parents’ needs eclipse needs of children
– Parents turn the focus away from maltreatment
allegations
– Parents make it difficult for practitioners to see children
alone
– Practitioners do not have sufficient experience/training
to help parents understand how their behaviour is
harmful to children
• Men, grandparents and siblings are often left out
of equation.
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Behaviours for practitioners to
avoid
Practitioners need to ensure they are not:
– Unwilling to make critical judgements
– Underestimating harm to children
– Developing ‘fixed views’ of families that are not updated
in light of contrary evidence
– Allowing their own anxieties to lead them to behave
negatively towards families
– Failing to involve families fully
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Challenges related to agencies
• Agency policies may encourage practitioners to
create a (false) dichotomy between ‘in need’ and ‘at
risk’ of harm
– Comprehensive assessments and services targeted
at children deemed to be suffering or being likely to
suffer significant harm
• Practitioners feel pressured to close cases quickly
and balance heavy caseloads
• Practitioners frustrated with long waits for or lack of
available specialist services.
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Challenges related to multi-agency working
• Poor information sharing and analysis within and
across agencies:
– Ofsted review indicated that individual agencies did
not have complete information on families’ histories
– Confusion regarding data protection/information
sharing
– Assessments were not sufficiently in-depth for
decision-making
– Varying thresholds for classifying significant harm
– Sheer number of agencies involved
• Child- and adult-focused practitioners may have
different priorities.
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Parents’ perspectives
• What practitioners perceive as resistance may be
parents’ lack of satisfaction with services
• Parents identified some negative traits they
associated with practitioners including judgemental,
cold, one-sided and insincere
• Parents did not always receive the help they asked
for
– Sought out informal sources of support
• Parents expressed frustration that they weren’t
involved in assessments and interventions.
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Implications
Practitioners may need
further training on how to
differentiate engagement
from compliance
Practitioners need to
maintain focus on the child
in complex cases
Need for
better analysis
of information
Practitioners need
adequate time to offer
targeted services
Practitioners need to
support parents, yet also
challenge them
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Making sense of responses
• Are you prepared? Plans & strategies?
• Could you have aggravated the situation? Is the hostility
a response to frustration?
• Does the person need to complain?
• Is behaviour deliberately threatening / obstructive?
• Is the person aware of impact having on you? Is s/he so
used to aggression that doesn’t appreciate impact?
• Is your discomfort disproportionate to what has been
said/done?
• Taking personally where hostility is aimed at agency?
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3. What services, treatments and
intervention are effective for
families that are resistant to
change?
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What makes a difference?
3 aspects:
• Interventions
• Interpersonal factors
• Assessment
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Research on effectiveness
• No studies examine effective services for
‘resistant’ or complex families
• A few studies look at impacts of various
programmes to prevent recurrence including:
– Intensive Family Preservation Services (IFPS) –
provide a range of intensive, short-term services in
the home
– Multi-component – provide a package of services
directed at identified problems
– Parent training – teach parenting strategies and help
parents improve skills.
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Research on effectiveness
Positive relationships with practitioners
Parental involvement
Practical help and social support for families
Services that help to build skills and
empower families
For children, stable relationships with
committed carers
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Research on effectiveness
• Long term continuity (as opposed to episodic
services)
• Centre-based delivery integrating targeted with
universal services
• Preceding or following intensive services with
lower-intensity ones (allowing families to reenter of their own volition if stresses re-occur)
• Services from specialist adult workers
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Engaging complex families
Child protection system is a powerful tool
– Practitioners should harness this power in a positive,
non-coercive manner
– Parents’ response depends on an honest
acknowledgement of power differential
– Honesty and transparency are important
– Workers need the ability to combine support and
control
Social workers and partners must be prepared to
ask direct questions on more than one occasion
about the impact of adult behaviours on the child
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Engaging complex families
SSCB Learning Review
• What worked
Multi-agency approach
Shared work plan
Agreement about outcomes needing to be achieved
Information sharing
Right services at the right time
• What didn’t work
Poor communication between agencies
Families dividing agencies
Discharge from services - ‘revolving door’
Unannounced visits
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Engaging complex families
Interpersonal factors
• Empathy and established relationships skills
such as active listening and demonstrable
respect are necessary practitioner behaviours
– But need to be balanced with healthy dose of
scepticism
– Evidence suggests that many practitioners display a
confrontational style
• Active involvement, with as much power as
possible given to families
• Experienced, skilled, persistent & resilient staff
(SSCB Learning review)
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Engaging complex families
written contracts
Practitioner Tips: Written Contracts
Consider drawing up a written contract with the family specifying:
a)
Exactly what behaviour is not acceptable e.g. raising of voice,
swearing, threatening etc.
b) Spelling out that this will be taken into account in any risk
assessment of the child/young person
c) Clearly explaining the consequences of continued poor behaviour
on their part- this could include undertaking joint visits, seeing
them only at the office; or for statutory agencies initiating action to
consider the removal of the child.
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Effective assessments
• Cannot underestimate the importance of good, in-depth
assessments
• Assessments should not be ‘one-off’ snapshots of
families’ behaviours, but should include:
– Observations – particularly, parent-child interactions
– Understanding of families’ histories
– Inclusion of the whole family unit
• Assessments should be sustained to ensure cases do
not lose momentum
• The collection of information needs to be coordinated
across practitioners.
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Effective assessments
Local Learning Points
• Assessments weakened by hostility of family –
deflected practitioners from focussing on needs
of young person
• Practitioners assessments must be evolving
pieces of work that can be developed and
changed as new information comes to light.
• Importance of information sharing systems
across agencies
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Observation
“There is an urgent need to review practitioners’ tendency to
rely almost exclusively on interviewing parents about their
parenting skills...Attention needs to be paid to observing
parent-child dynamics in order to assess caregivers actually
parenting, as distinct from describing how they
parent...Convincing evidence exists to show that simulating
sensitive parenting is very hard to sustain. But to accomplish
such a shift in emphasis it is likely that specific observational
techniques, such as understanding and recognising
disorganised attachment behaviour, will need to be acquired
by practitioners”
Focus on the Child
• If you feel threatened, what is it like for the child?
• Impact of hostility on the child:
oDe-sensitised to violence
oLearnt to appease and minimise
oSimply too frightened to tell
•Have you seen the child? Seen them alone?
Listened to them? Understood their views?
•What might the child have been feeling as the
door closed behind you?
Group exercise
Think of 5 questions which would help
you (or someone you supervise) to
assess the impact that resistance or
hostility could be having on your work
Please write down your agreed set of questions
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Implications for practice
In-depth
assessments
Coordinate
information
across
agencies
Balance
empathy with
scepticism
Observe
parent-child
interactions
Talk to children
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The role of supervision
• “It is only when skilled and committed workers have time
to spend time with and empathise with these parents
that it becomes possible to understand when important
information or serious problems are being concealed
and more intrusive measures to protect the child are
needed.
•
In these cases, to ensure that the child’s welfare
remains the paramount consideration, the role of an
equally skilled and knowledgeable casework
supervisor becomes even more vital”
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Effective supervision
• Most evidence mentions the importance of management &
supervision, few lessons on what works
• Circumstances where good supervision is essential include
when practitioners:
– Are overwhelmed/lacking confidence
– Experience violence
– Are acting out their own strong emotions
• A safe but challenging space to guard against rigid
adherence to a particular view, or jumping from one theory to
another without resolution
– Learning culture; dialectic mindset: playing the devil’s
advocate; bring in a fresh pair of eyes
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Effective Supervision
Supervisors need to be able to
•
•
•
•
•
Stand back to ensure that they have oversight
of a case
Use processes for regular review and follow-up
Give practitioners a sense of direction
Keep them on track, including reviewing
whether the current approach is working
Maintain a clear record of decision-making
Effective Supervision
Questions supervisors should ask practitioners
What are your assumptions about the family and where is the hard
evidence to support them?
At what points have you changed your assessment of the situation?
Would you have acted differently if this information had come from
another source?
What alternative explanations / goals might have existed?
What factors led you to the chosen option?
Might there be other explanations?
How might others describe and explain what is going on?
Can you picture what life is like for this child?
Does your original hypothesis still make sense?
Do you need to change your view?
Which case are you most worried about and why?
Which case are you least worried about and why?
Staff Care & Safety
• Critical role of managers
• Stereotypical assumptions
– Males present higher levels of risk
– Male workers less likely to be intimidated
• Culture of denial, minimising, ‘part of the job’
• Impact of violence or abuse on identity / selfimage
• Worker takes on role of family mediator
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Staff Care & Safety
Practitioner Tips: Keeping yourself safe
• Acquaint yourself with your agreed agency procedures e.g. there may be
a requirement to ensure the police are informed of certain situations.
• Don’t go unprepared: be aware of the situation and the likely response
• Don’t make assumptions that previously non-hostile situations will always
be so
• Don’t put yourself in a potentially violent situation. Feel safe and in
control at all times
• Get out if it is getting threatening
If an incident occurs:
• Try to stay calm and in control of your feelings
• Make a judgement of whether to stay or leave without delay
• Contact your manager immediately
• Follow your agency’s post-incident procedures including recording.
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Staff Care & Safety
Top Tips for Managers
• Keep Health & Safety regularly on agenda of team meetings
• Ensure H&S is on all new employee inductions
• Ensure staff have the confidence to speak to you about concerns
relating to families
• Prioritise case supervisions and do not cancel
• Ensure you have a monitoring system for home visits
• Analyse and regularly update team training
• Ensure everyone knows how to respond in an emergency
• Empower staff to take charge of situations, be confident in their
actions
• Recognise individual dynamics, acknowledge impact on individuals
• Pay attention to staff safety when allocating workloads
• Be aware what is happening in local communities
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Using Management Processes
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Risk management
Violence to Staff policies
Case auditing
Learning reviews
Performance Management
Use of ‘near miss’ or serious incident
investigations
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Final Summary
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The importance of this area of work
Underpinning knowledge
Challenges to practice
Skills and ‘what works’ – effective practice
Importance of assessments
Focus on child, observations & triangulation
Joint working
Trust and empowerment
Need for good supervision and staff care
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Challenge or opportunity?
• Implications must be considered within current
policy context
• Crisis of confidence in the system …
• At a time of increased referrals, fewer resources
and less national guidance
• BUT Munro review provides opportunity to
refocus on content rather than process
• Review findings fit well within this approach –
rediscovering professional judgement
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Where next?
• As a result of the learning you have
undertaken, what do you intend to do
differently?
• What support will you need?
• How will you know if you have been
successful?
And Finally…..
Evaluation
THANK YOU
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