Why is this review important?

1. Effective practice to protect children living in ‘highly resistant’ familiesRebecca Fauth, Helena Jelicic, Diane Hart and Sheryl Burton,NCBProf David Shemmings,University of Kent

2. Why is this review important? • Recent high profile child protection cases have raised concern about some extremely ‘resistant’ families who do not change despite intervention • Although we do not have numbers, 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

3. What is resistance? Ambivalence Denial/Avoidance Unresponsiveness to treatment/Disguised compliance Violence/Hostility

4. Review questions • What are the circumstances, characteristics and prevalence of families that are resistant to change? • What challenges to practice do resistance, and the underlying characteristics and circumstances, raise? • What services, treatments and interventions are effective for families that are resistant to change?

5. The 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.

6. 1. What are the circumstances, characteristics and prevalence of families that are resistant to change?

7. Circumstances and characteristics Key circumstances associated with recurrence: • Families’ history of abuse, particularly substantiated and repeated prior reports, consistently associated with recurrence • Possibility of labelling and further scrutiny of these families? • Multiple, simultaneous problems • Domestic violence, substance misuse, mental health problems, criminal activity, lack of financial resources, low social support • Lack of timely services and assessments.

8. 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.

9. 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.

10. Implications

11. 2. What challenges to practice do resistance, and the underlying characteristics and circumstances, raise?

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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.

18. Implications

19. 3. What services, treatments and intervention are effective for families that are resistant to change?

20. 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.

21. Research on effectiveness

22. Engaging complex families • Child protection system is a powerful tool • Practitioners should harness this power in a positive, non-coercive manner • Honesty and transparency are important • 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 practitioners may display a confrontational style.

23. 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.

24. Effective supervision • Most evidence mentions the importance of management and supervision to safeguarding practice, but few lessons on what works • Supervision is always important, but some circumstances where good supervision is absolutely essential include when practitioners: • Are overwhelmed/lacking confidence • Experience violence/fear • Are acting out their own strong emotions

25. Implications • Need for specific research that focuses on which services, treatments or interventions are effective for complex families • Very little research focuses on children’s outcomes beyond preventing recurrence • Attitudes and behaviours of individual practitioners seem to have an effect on whether families engage or not • Improving practitioners’ ability to make more accurate and robust assessments would enhance services.

26. Key overall messages • Need to reduce reliance on interviewing parents (mainly mothers) • Need for more sophisticated and developed understanding and analysis of strengths • Need for training and development in a range of areas: • Complex analysis and reflection • Use of relevant theories and research-mindedness • Engaging children, men, grandparents, etc. • Need for good supervision – and further research into its effective components.

27. Implications for practice

28. Useful resources • C4EO Safeguarding expert briefings available at: http://www.c4eo.org.uk/themes/safeguarding/ • Information and guidance on the Common Assessment Framework: http://www.dcsf.gov.uk/everychildmatters/strategy/deliveringservices1/caf/cafframework/ • Hart, D & Powell, J. (2006) Adult drug problems, children’s needs: assessing the impact of parental drug use. London: NCB: http://www.ncb.org.uk/resources/publications.aspx • Dalzell, R & Sawyer, E (2007) Putting analysis into assessment: undertaking assessments of need. London: NCB: http://www.ncb.org.uk/resources/publications.aspx