Working with ‘disguised compliance’ and resistant families

1. Working with ‘disguised compliance’and resistant families Sue Woolmore June 2010

2. Resistant or reluctant? “A problem for social workers and others is that coverage of recent high profile cases in some parts of the media has contributed to an impression of all parents who maltreat their children as conniving, cold-blooded individuals, set on abusing or even killing a child and, in the process, deliberately setting out to deceive the authorities.” C4EO knowledge review 2010

3. Resistant or reluctant? “Irrespective of whether they co-operate, it is worth remembering that most parents involved in the child welfare system are involuntary participants in a process they may resent.” C4EO knowledge review 2010

4. Sources of knowledge and thinking • Biennial SCR studies • Academic commentary • C4EO commissioned knowledge review • Practice experience • Reflective supervision

5. ‘Disguised compliance’ Identified in Beyond Blame 1993 Family provides sufficient evidence to convince workers that it is co-operating with agencies to protect the child, whilst effectively neutralising professional concern and insight into reality of the child’s life experience. Colloquially described as, “doing enough to get social services off my back”

6. Examples of disguised compliance • clean the house week before review • school attendance improves for 2 weeks • welcome, rather than usual hostility, at home visit • plausible excuses for missed appointments • presenting for clinic appointment day before crucial home visit

7. Identifying disguised compliance • conflicting accounts of family life from family members • conflicting accounts/evidence from different professionals • conflicting accounts from neighbours • persistently unmet needs of children • presentation and behaviour of children conflicts with adult accounts • repeat incidents of harm/neglect to children • analysis of detailed, multi-agency chronology • observation of parent child interaction (there is convincing evidence that simulated sensitive parenting is very difficult to sustain - C4EO 2010)

8. Close associates • Dependency • workers’ belief that helping parents helps the child • potential competition for worker’s attention • Closure • family tightens boundary around itself to exclude professionals e.g. closed curtains, missed appointments • the more interest/control shown by professionals, the more threatened family feels • increased vulnerability for child as family ‘closes’ • Flight • family closes boundaries further by moving elsewhere Beyond Blame 1993 – Reder et al

9. Learning from Serious Case Reviews “Apparent or disguised cooperation from parents often prevented or delayed understanding of the severity of harm to the child and cases drifted. Where parents made it difficult for professionals to see children or engineered the focus away from allegations of harm, children went unseen and unheard.” Biennial analysis of Serious Case Reviews 2003 - 2005

10. Collusion with disguised compliance? • Rule of optimism • workers are required, if possible, to think the best of carers • ‘Start again syndrome’ • attractive to both practitioners and managers • past is complex, overwhelming, sense of helplessness • clean slate – ‘intelligence’ from history is lost

11. Ingredients for ‘resistance’ Ambivalence Denial/Avoidance Unresponsiveness to treatment/ disguised compliance Violence/Hostility C4EO knowledge review 2010

12. Learning from Serious Case Reviews Almost 75% parents/carers characterised as uncooperative: • hostility towards workers • actively avoiding contact with workers • missed appointments • disguised compliance • ambivalence Biennial analysis of Serious Case Reviews 2005 - 2007

13. Messages for practice with resistance • Children in families without detailed assessment four times more likely to suffer repeat abuse • Information for assessments must be organised and analysed • Sources of information other than just mother must be sought • Direct observation of parent-child interaction is essential • Consistent message about effective supervision C4EO knowledge review 2010

14. Challenges for practice with resistance • Working with complex families, practitioners focus too much on small improvements, rather than context of family history • Parents’ needs eclipse needs of children • Parents make it difficult to see child alone • Men, grandparents and siblings often left out of picture • Practitioners feel pressurised to close cases quickly • Agency policies encourage workers to create a (false) dichotomy between ‘in need’ and ‘at risk’ of harm C4EO knowledge review 2010

15. Effective interventions with resistance • Focused, long term services, rather than episodic interventions • Accuracy of assessments enhance service, including attachment behaviours and detailed family history • Child protection system is powerful tool – practitioners should harness power • Attitudes and behaviour of practitioners have major effect on families’ engagement • Workers need to show empathy and acceptance, coupled with an authoritative, child focus • Services that include practical help for families C4EO knowledge review 2010

16. Resistance or poor services? • What practitioners perceive as resistance may actually be family’s lack of satisfaction with services • Parents express frustration when not involved in assessments and interventions • Parents don’t always receive help they ask for • Negative traits in practitioners cited: cold, insincere, one-sided C4EO knowledge review 2010

17. Role of supervision “Supervision helps practitioners to think, to explain and to understand. It also helps them to cope with the complex emotional demands of work with children and their families.” Biennial analysis of Serious Case Reviews 2003 – 2005

18. Reflective practice • Mature practice should critically review and revise judgements about family functioning and risk: • admitting you might be wrong is powerful weapon against making crucial errors • there is tendency to form a judgement and then stick with it, despite contrary evidence • alternative temptation to swap one theory for another and not reach a coherent conclusion

19. Reflective practice “Reflective practice needs to be supported at the individual, team and agency level and requires careful nurturing, time and space in which to thrive.” Safeguarding : Briefing 3 C4EO Sheryl Burton , National Children’s Bureau

20. References Beyond Blame: child abuse tragedies revisited 1993Peter Reder, Sylvia Duncan, Moira Gray A required mind-set for child protection practice: comments on Munroe (1999) Peter Reder and Sylvia Duncan Letter to the editor Child Abuse and Neglect vol 24, No 4, pp 443-445, 2000 Analysing child deaths and serious injury through abuse and neglect: what can we learn? A biennial analysis of serious case reviews 2003-2005 Brandon et al Effective practice to protect children living in ‘highly resistant’ families Rebecca Fauth, Helena Jelicic, Diane Hart, Sheryl Burton, David Shemmings Knowledge Review published by C4EO 2010 The oversight and review of cases in the light of changing circumstances and new information: how do people respond to new (and challenging) information? Sheryl Burton , National Children’s Bureau Avoidable and unavoidable mistakes in child protection work Eileen Munroe British Journal of Social Work (1996) 26, 793 – 808