Working with Parents where Improved Outcomes for Children are not Achieved
How to have Difficult Conversations with Parents/Carers
Professional curiosity & challenge – resources for practitioners
This chapter was added to the manual in November 2022.
This guidance addresses issues that arise when practitioners are working with parents where improved outcomes for children are not achieved. Resistance may be expressed in aggression, in open refusal to cooperate, or in missed appointments and other forms of avoidance, or it may be masked by superficial cooperation. The common feature in all cases is failure to change, and a refusal or inability to acknowledge or address the risk to the child’s welfare. In extreme cases there can be intimidation, abuse, threats of violence and actual violence towards practitioners. If a practitioner feels intimidated, scared they must consider what it must be like for the child living in the household. The welfare of that child person is paramount at all times.
The guidance aims to help practitioners to:
- Understand the variety of ways in which families can display resistance, hostility to change, disguised compliance and/or coercive control behaviours
- Increase awareness of strategies practitioners may be able to employ in order to reduce the likelihood of non-co-operation;
- Maintain control of situations and keep themselves safe;
- Be in a position to effectively assess the risk factors affecting children in the household, and ensure children are safeguarded and their welfare promoted. Make an authoritative response to the resistant family, making it clear that non co-operation is not acceptable.
- Work with other practitioners to reach a view about whether a family is displaying ambivalence but with whom they can work, or deliberate behaviour which means change is much more difficult to achieve.
It is helpful if agencies publish a clear statement about unacceptable behaviour by those accessing their services. This guidance should be considered alongside individual practitioner codes of conduct.
2. Risks and Practice Implications
The techniques by which parents resist change tend to draw attention toward their needs and away from the child’s needs, and to draw the focus of work toward achieving their cooperation rather than ensuring that the child receives adequate care. The consequential effect of this is to create a situation in which the child remains at risk of significant harm and there is no sustained improvement in their care. Ultimately the child will fail to thrive in this environment.
It can be more difficult for practitioners to identify the challenges in working with parents who appear pleasant and amenable, agree with the need for change, but who are unable or unwilling, despite interventions, to bring this about satisfactorily. The term 'highly resistant' sits on a continuum. At one end a certain degree of reluctance on the part of parents who know they need help but find it hard to accept can be predicted. At the other end are a small number of highly manipulative parents who are very accomplished at misleading practitioners. This is referred to as 'disguised compliance'.
In some family relationships there can be a strong element of 'coercive control' occurring. Coercive control describes a range of patterns of behaviour that enable a parent to retain or regain control of a partner, ex-partner or children. The impact of coercive control within families can have a significant effect on how family members respond to practitioners, even when they are highly motivated to change their situation. In such situations victims may feel it impossible to talk openly and honestly with practitioners despite a desire to do so. Practitioners need to be aware of the impact on the behaviour of victims where there are high levels of fear and difficulties articulating the abuse and what makes them afraid. It is possible for practitioners to unwittingly collude with the perpetrator, further isolating the victims within the family. Evidence suggests that perpetrators of coercive control do not easily cease their abusive behaviour, often seeking to manipulate and control practitioners or making allegations about the victims. Often victims of control and coercion do not recognise that they are victims which makes engagement problematic for practitioners.
In such cases it is important that practitioners are professionally curious. Professional curiosity is a combination of looking, listening, asking direct questions, checking out and reflecting on information received. It means not taking a single source of information and accepting it at face value. It means testing out your assumptions about different types of families. It means triangulating information from different sources to gain a better understanding of family functioning which, in turn, helps to make predictions about what is likely to happen in the future. It means seeing past the obvious.
Working Together to Safeguard Children makes it clear that no single practitioner can have a full picture of a child’s needs and circumstances and, if children and families are to receive the right help at the right time, everyone who comes into contact with them has a role to play in identifying concerns, sharing information and taking prompt action. It is the sharing of information with other agencies that can help identify the truth or otherwise of a situation. If criminal offences are identified, support for reporting to authorities including the Police should be encouraged as this can provide intervention to disrupt the coercive control by the perpetrator. If children are identified as victims safeguarding procedures should be followed in line with ‘Working Together to Safeguard Children’.
Resistance may be expressed in overt refusal to cooperate with services to protect children at risk of harm. Resistance may be masked by outward compliance which is not carried through in practice, for example when parents fail to carry out agreed tasks, or where there are repeated missed appointments. This is often referred to as Disguised Compliance. Indicators of disguised compliance or resistance might include:
- No significant change at reviews despite significant input;
- Persistent or intermittent failure to keep appointments;
- Parents agreeing with practitioners regarding required changes but put little effort into making changes work;
- Change occurs but as a result of external agencies/resources, not the parents’ efforts;
- Parents engaging with certain aspects of a plan only;
- Change in one area of functioning is not matched by change in other areas;
- Parents aligning themselves with certain practitioners;
- Parents attempting to refocus the attention of practitioners, such as through repeated lodging of complaints or presenting a pattern of crises which detract from planned interventions;
- Child's report of the situation is in conflict with report from parent.
The possibility of resistance to change should be considered when interventions fail to provide timely improved outcomes for the child. However before concluding that a family is resistant to change, the practitioner should consider whether the parents understand what is expected of them and why it is necessary. When practitioners use the term disguised compliance in case notes, examples or evidence should be provided to support this. Practitioners should be conscious of the right of parents to challenge any practitioner’s interpretation of events, assessment of their child’s needs, or assessment of risk to the child. This does not constitute resistance, provided that the child’s safety and welfare is safeguarded.
Examples of coercive and controlling behaviours might include:
- Controlling or observing victim's daily activities, including being made to account for their time, restricting access to money, restricting their movements;
- Isolating the victim from family/friends; intercepting messages or phone calls;
- Constant criticism of victim;
- Threats of suicide, homicide or familicide;
- Preventing the victim from taking medication or accessing care;
- Using children to control a partner;
- Extreme dominance;
- Extreme jealousy;
- Damage to property, including pets;
- Threats to expose sensitive information (e.g. sexual activity) or make false allegations;
- Involvement of wider family members/community; crimes in the name of 'honour';
- Manipulation of information given to practitioners.
Parents who demonstrate resistance through aggression or open hostility towards practitioners can be extremely intimidating. Behaviours may be deliberately used to keep practitioners at bay, or can have the effect of keeping practitioners at bay. Practitioners may find themselves seeking to avoid difficult or challenging interventions with the family, either consciously or unconsciously, and this dynamic must be addressed during supervision in order to ensure that the safeguarding needs of the children in the family are firmly kept in focus.
Some coping strategies developed by practitioners which can obstruct engagement with families are:
- Seeing each situation as a potential threat and developing a 'flight' response whereby the practitioner can be overly-challenging, thus increasing the tension between him or herself and the family. This may protect the practitioner physically and emotionally, but can lead to desensitisation to the child's pain and to the levels of aggression which exists within the home. As a result, the harm to the child can be under-estimated.
- Colluding with parents by accommodating and appeasing them in order to avoid provoking a reaction
- Becoming hyper alert to the personal threat so that the practitioner becomes less able to listen accurately to what is being said or is distracted from observing important responses by the child or interactions between the child and other family members
- 'Filtering out' negative information or minimising the extent or impact of the child's experiences in order to avoid having to challenge. At its extreme, this can result in practitioners avoiding making difficult visits or avoiding meeting with those adults in their home, thus losing important information about the home environment.
- Feeling helpless or professionally paralysed by the dilemma of deciding whether to 'go in heavy' or 'back off'. This may be either when faced with escalating concerns about a child or when the hostile barrier between the family and outside means that evidence about the child's situation appears minimal.
It is important to realise that where an individual is perceived as intimidating or dangerous to practitioners, there is a strong possibility that they are also dangerous to the children and other members of the family. If practitioners are scared and intimidated, it is very likely that any children in that individual's care may be at risk.
4. Protection and Action to be Taken
When a practitioner feels that a family may be resisting change that is necessary to safeguard the child’s welfare, they should:
- Assess the evidence;
- Inform a supervisor
- Consult other practitioners and consider arranging a professionals or Stop and Review meeting;
- Revisit the causes for concern;
- Weigh the level of resistance and the seriousness of the concerns;
- Ensure that agencies coordinate their efforts; and
- Arrange a review of the risk assessment including the impact of delay on the child’s development and safety.
- Confirm parent understanding of what is expected from them
The practitioner should check the records of contact with the family and estimate the size of the problem:
- Consider any reasons the family give for their failure to progress. Are they plausible? What action can be taken to test whether the problems come from circumstances that are genuinely beyond their control or from a refusal to cooperate?
- If the family cooperate in keeping contact, but no progress is evident, check whether clear expectations were stated, what tasks were agreed and what proportion of them were completed. Have certain tasks been completed satisfactorily? Have some tasks been agreed repeatedly but not carried out? What is the significance of the tasks that have and have not been addressed in terms of the child’s welfare? Particular consideration should be given as to how the delay in change being achieved impacts on the child’s development;
- If concerns arise because of failed contact, practitioners should analyse the risk to the child. One failed contact may require immediate action, such as making a referral to the Children’s Services, or if less urgent, may benefit from a discussion with other practitioners to identify how often the family allows other practitioners to see the child, talk to them alone or check their living conditions;
- If family members are hostile/aggressive assess how far their hostility is impacting on the assessment by considering the following questions:
- Am I colluding with parents by avoiding conflict, e.g. focusing on less contentious issues, avoiding asking to look round the house, or not asking to see the child alone?
- Am I changing my behaviour to avoid conflict?
- Am I filtering out negative information or minimising?
- Am I afraid to confront family members?
- What message am I giving this family if I don't challenge?
- Am I relieved when there is no answer at the door/when I get back out of the door?
- Did I say, ask and do what I would usually say, ask and do when making a visit or assessment?
- Am I working with the key people or focussing on the less intimidating family members.
Any practitioner who identifies resistance, or is concerned about whether there is a dynamic with a hostile family which is impacting on the assessment or intervention, should discuss this with their own supervisor before reporting it to the Lead Practitioner, who will consult all the practitioners involved with the family. This may be done, as part of the Early Help Plan, through the Core Group, or by reconvening a strategy meeting to establish whether this requires a Sec 47 response which could lead to a child protection conference, depending on the level of concern and threshold at which the concerns are being monitored. It is important to identify whether the resistance relates to a single agency/ practitioner or to several, and whether there are any practitioners working with the family who do not experience resistance.
Practitioners should consider the nature and seriousness of the current reasons for concern for the child’s welfare. These may not be immediately clear as:
- A family may avoid engagement by drawing attention away from the child’s needs and toward the needs of parents or other family members; and
- A family that avoids engagement may present as motivated to address their child’s needs but encountering difficulties in doing so.
Practitioners should carefully reassess the seriousness of the concerns in the context of the evidence of resistance. When there is concern about a child’s welfare, and the family take positive action to conceal information, this is in itself a risk factor, but the total assessment of risk must be based on the evidence as to whether or not the child’s needs, including the need for protection, are being met.
When resistance is identified in a family it is essential that work remains focused on the child’s welfare. Agencies should coordinate their actions to take advantage of any good relationships the family may have with practitioners.
Practitioners must ensure that the aims and objectives of a plan (e.g. Early Help, Child in Need or Child Protection) are clear, and that each agency’s role in the plan is clear. It may be appropriate to reallocate responsibility for some tasks, but any change must be justified in terms of meeting the child’s needs.
If insufficient progress is made in achieving the tasks set out in the plan, the practitioners must reconvene to reconsider the risk assessment. The meeting (e.g. core group) must consider whether the threshold for action to escalate concerns (e.g. escalate to child protection or evoke PLO proceedings) has been passed - if there is resistance to change, the risk is not reducing, and it may be increasing. Action and decisions should be assessed by managers to prevent any drift and delay in meeting the child’s needs.
If it has been agreed that change is necessary to safeguard the child’s welfare, the plan has not been effective unless there is progress in achieving that change. If the frequency of contact with the child is inadequate it is not possible to know whether the risk is increasing, reducing or staying the same, and the plan is unsafe. If this is identified action should be taken without delay.
When resistance is recognised in a family, attention may be diverted to the resistance itself, however focus should remain on whether the risk to the child is increasing or decreasing, or has changed in nature.
If one or more agencies have established reasonable relationships with the family, these relationships should be identified and appointed to become the Lead Practitioner/agencies to maintain communication to balance the difficulties experienced by other agencies, provided that appropriate progress is being made as set out in the plan.
5. Recognising and Making Sense of Lack of Cooperation
A common pattern of Non-cooperation is when parents do not comply with what has been agreed with them. As a result, practitioners become stricter in their approach, and start imposing more rules, for example. The parent may, as a result, make an appointment to appease the practitioner, with the GP, dentist, health visitor etc. but then does not attend. They have a plausible excuse for their non-attendance and make another appointment, which they subsequently do not attend. Each time the uncooperative parent does just enough to keep practitioners away. There are other types of uncooperativeness, as outlined below. This is not an exhaustive list;
- Ambivalence can be seen when people are always late for appointments, or repeatedly make excuses for missing them; when they change the conversation away from uncomfortable topics and when they use dismissive body language. Ambivalence is the most common reaction and may not amount to uncooperativeness. No service user is without ambivalence at some stage in the helping process. We are all ambivalent about the dependency involved in being helped by others. It may reflect cultural differences, not being clear about what is expected, or be about poor previous experiences of involvement with practitioners. Ambivalence may need to be acknowledged, but it can be readily worked through;
- Avoidance is a very common method of uncooperativeness and includes avoiding appointments, missing meetings, and cutting short visits due to other apparent important activity (often because the prospect of involvement makes the person anxious and they hope to escape it). Extreme avoidance may include not answering the door, as opposed to not being in. They may clearly have a problem, have something to hide, resent outside interference or find staff changes difficult. They may face up to the contact as they realise the practitioner is resolute in their intention, and may become able to engage as they perceive the practitioner's concern for them and their wish to help;
- Confrontation includes challenging practitioners, provoking arguments, and often indicates a deep-seated lack of trust leading to a 'fight' rather than 'flight' response to difficult situations. Parents may fear, perhaps realistically, that their children may be taken away or they may be reacting to them having being taken away. They may have difficulty in consistently seeing the practitioner's good intent and be suspicious of their motives. It is important for the practitioner to be clear about their role and purpose, demonstrate a concern to help, but not to expect an open relationship to begin with. However, the parent's uncooperativeness must be challenged, so that they become aware that the practitioner/agency will not give up. If the practitioner involved faces this kind of confrontation and verbal aggression, they should seek advice and support from their manager in finding the most effective way to continue to work with the family (see Section 13, Keeping Workers Safe);
- Violence: It may reflect a deep and long-standing fear and projected hatred of authority figures. People may have experience of getting their way through intimidation and violent behaviour. The practitioner/agency will need to be realistic about the capacity for change in the context of an offer of help with the areas that need to be addressed. If necessary the children should be referred for Section 47 enquiries, and this may entail them being removed from the family home for assessment. Keeping workers safe in such situations is vital (see Section 13, Keeping Workers Safe).
Reasons for non-engaging families
There are a variety of reasons why some families may not engage with practitioners, including:
- They do not want their privacy invaded and resent outside interference;
- They have something to hide and/or don't think they have a problem;
- They perceive there are cultural differences;
- They do not understand what is being expected of them;
- They have previously had poor experience of involvement with practitioners and fear being judged to be poor parents because of substance misuse, domestic abuse, mental health or other problems;
- They dislike staff changes and multiple practitioners involved in their family (having to tell their story over and over again) and/or dislike or fear authority figures;
- They fear their children will be taken away or they feel they have nothing to lose, for example when the children have already been removed.
It is important to remember that a range of social, cultural and psychological factors influence the behaviour of parents, as well as issues such as substance use or mental health. See also Working with Problematic use of Drugs or Alcohol within Families. But the more uncooperative the family, the more likely it is that the main influences are psychological, stemming from the parent's adverse experiences in their own childhoods. Some people, for whatever reason, may also have aggressive and violent traits in their personality. As an adult, the parent will try to regain control over their lives, but they may be overwhelmed by pain, depression, anxiety and guilt resulting from their earlier loss. Paradoxically the uncooperativeness may occur as they open up their feelings, albeit negative ones, at the prospect of help. They may not be aware of this process going on.
6. Isolation of a Child
Uncooperative parents may isolate their children from agency involvement, especially if they are attempting to hide abuse or neglect that is taking place within the family. Indicators of a child being isolated in such a way may include significant periods of absence from school, Elective Home Education or non-engagement with health agencies such as GP, health visitor, specialist health practitioner etc.
A child's absence from school may be supported by the parent, therefore, they may not be recorded as removed from school or truanting. This may mean they do not come to the attention of the Children Missing from Education Teams, as they are officially still attending. Significant periods of absence should be monitored by schools and early year’s settings (although attendance at early years setting is not a statutory requirement), and action taken according as specified within the school's procedures.
7. Impact on the Assessment of Children and Families
Accurate information and a clear understanding of what is happening to a child within their family and community, is vital to any assessment. The usual and most effective way to achieve this is by engaging parents and their children in the process of assessment, reaching a shared view of what needs to change and what support is needed, and jointly planning the next steps.
Engaging with a parent who is resistant or even violent and / or intimidating is obviously more difficult. The behaviour may be deliberately used to keep practitioners at bay, or can have the effect of keeping practitioners at bay. There may be practical restrictions to the ordinary tools of assessment - for example, observing the child in their own home. The usual sources of information, for example other practitioners and other family members may also be kept at bay by the family. It is important to explicitly work out and record what areas of assessment are difficult to achieve and why. The presence of violence or intimidation needs to be included in any assessment of risk to the child living in such an environment.
If you feel threatened by the parent, think what life must be like at home for their child. May require an immediate safeguarding referral, alerting other practitioners working with the family of the possible risks/threats to the child and them and flagging the concerns on the child’s file.
7.1 The impact on the child
The practitioner needs to be mindful of the impact the hostility to outsiders may be having on the day-to-day life of the child. They may:
- Have become de-sensitised to violence and abuse;
- Have learnt to appease and minimise - remember Victoria Climbie always smiled in the presence of practitioners;
- Be simply too frightened to tell;
- Identify with the aggressor.
7.2 The Impact on your Assessment
In order to assess to what extent the hostility of the parents is impacting on your assessment of the child, it may help to ask yourself:
Am I focusing on the needs of the child?
- Am I colluding with the parents by avoiding conflict, for example focussing on less contentious issues such as benefits/housing; avoiding asking to look round the house, not looking to see how much food is available; not inspecting the conditions in which the child / sleeps, etc. or, crucially, not asking to see the child alone?
- Am I changing my behaviour to avoid conflict? Your behaviour may need to change to adapt to the situation, but the content of what you say and the outcomes you desire should remain unchanged;
- Am I filtering out or minimising negative information?
- Am I afraid to confront family members about my concerns?
- Am I keeping my worries to myself and not sharing risks and assessment with others in the inter-agency network or manager?
- Is the child keeping 'safe' by not telling me things?
- Has the child learned to appease and minimise?
- Is the child blaming him or herself?
- What message am I giving this family if I don't challenge?
- Am I relieved when there is no answer at the door?
- Am I relieved when I get back out of the door?
- Did I say / ask / do what I would usually say / ask / do when making a visit or doing an assessment?
- Have I identified and seen the key people?
- Have I observed evidence of others who could be living in the house, when I have not been told there is anyone else living there?
- Is this a case of Domestic Abuse but I am only working with the adult victim?
- What might the children have been feeling as the door closed behind me?
- Am I checking my own bias (cultural)?
8. Impact on Multi-Agency Work
All agencies need to work in partnership with families to achieve the agreed outcome. However, all parties involved need to understand this partnership may not be equal, depending on whether the involvement is with statutory or voluntary agencies. Non-statutory agencies may need to access advice and potentially escalate the case to Social Care if they feel the family are not co-operating with them on a voluntary basis, or if the family fail to improve the lived experience of the child/children despite attempts to intervene early.
Sometimes parents may be hostile to specific agencies or individuals. If the hostility is not universal, then agencies should seek to understand why this might be and learn from each other. Where hostility towards most agencies is experienced, this needs to be managed on an inter-agency basis otherwise the results can be as follows:
- Everyone 'backs off', leaving the child unprotected;
- The family is 'punished' by withholding of services as everyone 'sees it as a fight'. This is at the expense of assessing and resolving the situation for the child;
- There is a divide between those who want to appease and those who want to oppose - or everyone colludes;
- Hostility is accepted in order to provide essential services to the child, but other safeguarding needs are overlooked.
When parents are only hostile to some individuals/agencies or where individuals become targets of intimidation intermittently, the risk to good inter-agency collaboration is probably at its greatest. Any pre-existing tensions between agencies and individuals, or misunderstandings about different roles are likely to surface. The risks are that splits occur between the agencies/individuals, with tensions and disagreement taking the focus from the child, for example:
- Individuals/agencies blame each other, and collude with the family;
- Those not feeling under threat can find themselves taking sole responsibility which can ultimately increase the risk to themselves;
- Those feeling 'approved of' may feel personally gratified as the family 'ally' but then be unable to recognise/accept risks or problems;
- Those feeling under threat may feel that it is personal;
- There is no unified and consistent plan.
8.1 Ensuring Effective Multi-Agency Working
Staff should alert other practitioners who know a family to be aware of potential difficulties and risks. Any agency faced with incidents of threats, hostility or violence should routinely consider the potential implications for any other agency involved with the family as well as for its own staff and should alert them to the nature of the risks. Regular inter-agency communication, clear mutual expectations and attitudes of mutual respect and trust are the core of inter-agency working. When working with hostile or violent parents, the need for good inter-agency collaboration and trust is paramount and is also likely to be put under greatest pressure. It becomes particularly important that everyone is:
- Aware of the impact of hostility on their own response and that of others;
- Respectful of the concerns of others;
- Alert to the need to share relevant information about safety concerns;
- Actively supportive of each other and aware of the differing problems which different agencies have in working within these sorts of circumstances;
- Open and honest when disagreeing;
- Aware of the risks of collusion and of the targeting of specific practitioners/agencies;
- Prepared to discuss strategies if one agency (for example a health visitor) is unable to work with a family - how will information/monitoring be gained and is it possible to have a truly multi-agency plan?
Caution may be needed about how to disclose personal information about certain family members to other services. Concerns about possible repercussions from someone who can be hostile and intimidating may be an added worry. However, information sharing is pivotal in order to safeguard and promote the welfare of children, as is practitioners being explicit about their experiences of hostility, intimidation or violence with named individuals. See Pan Bedfordshire Practitioner's Guide to Information Sharing to Safeguard Children and Young People for more information. It is important that you are open and honest with parents and other family members when you have to share information about them with other services. You should tell them what information you are sharing, with whom and for what purpose. However, you should not inform them if so doing would jeopardise the safety of a child, yourself or others.
If you answer yes to any of the following questions, you should share them with your manager and any other practitioners involved with the family:
|Do you have previous experience of the adult linked to the child being hostile, intimidating, threatening or actually violent to adults and/or children?|
|Is it general or in specific circumstances? - for example drink related/linked to intermittent mental health problems?|
|Are you intimidated/ fearful of the adult?|
|Do you feel you may have been less than honest with the family to avoid conflict?|
|Are you now in a position where you will have to acknowledge concerns for the first time? - and are you fearful how they will respond to you?|
|In their position, would you want to be made aware of these concerns?|
8.2 Child Protection Conferences, Core Groups and Multi-Agency Meetings
Avoiding people who are hostile is a normal human response; however, it can be very damaging for effective inter-agency work under Child Protection Plans, which depend on proactive engagement by all practitioners with the family. Collusion and splitting between agencies will be reduced by:
- Clear agreements, known to all agencies and to the family, detailing each practitioner's role and the tasks to be undertaken by them;
- Full participation at regular multi-agency meetings, Core Group meetings and at Child Protection Conferences with all agencies owning the concerns for the child rather than leaving it to a few to face the family.
Although it is important to remain in a positive relationship with the family as far as possible, this should not be at the expense of being able to share real concerns about intimidation and threat of violence.
Options to consider are:
- Discussing with the Child Protection Chair the option of using the exclusion criteria if the quality of information shared is likely to be impaired by the presence of threatening adults - see Child Protection Conferences Procedure, Involving the Child and Family Members;
- Holding a Stop and Review Meeting to share concerns, information and strategies and to draw up an effective work plan that clearly shares decision-making and responsibilities. If such meetings are held, there must always be an explicit plan made of what / how / when to share what has gone on with the family. Secret discussions are unlikely to remain secret, and the aim should always be to empower the Core Group to become more direct and assertive with the family without compromising their own safety;
- Holding a meeting to draw up an explicit risk reduction plan for practitioners and in extreme situations, instituting repeat meetings explicitly to review the risks to practitioners and to put strategies in place to reduce these risks;
- Joint visits with colleagues or practitioners from other agencies. Police may be involved if necessary (need to explain why they are in attendance);
- If practitioners have experienced a frightening event, debriefing with other agencies, as well as own colleagues, can be helpful.
Remember that although working with hostile families can be particularly challenging, the safety of the child is a practitioner’s first concern. If a practitioner is too scared to confront the family, consider what life is like for the child.
9. Responding to Uncooperative Families
What Should I Do?
Unfortunately, for the practitioner making the approach, the underlying feelings of the family may be masked by anger or avoidance, as these parents do not easily trust and may be fearful of closeness. It is best for the practitioner to be honest, giving clear indications that the aim of the work is to achieve the best for their child.
It is essential that the parent recognise that you are a practitioner with the authority to be involved with their family. To do this you must clearly state your practitioner authority, and balance support with challenge. The motivations and capacities of the adults to respond cooperatively in the interests of their children, with the help of the practitioner and their agency will need to be continuously assessed. However, both control and care will be needed, and the practitioner must confront uncooperativeness when it arises, albeit with understanding and empathy.
You should seek supervision from your manager or advice from senior staff Safeguarding Leads to ensure you are progressing appropriately with the family and include the CP Chair.
If you are going to be involved over a longer period, you will need to help the parent to work through their underlying feelings as you support them to engage in the tasks of responsible child care. In some cases, despite making every effort to understand and engage the parents, you may find the family remains completely resistant and will not allow you to become involved. In such cases you should discuss with your manager, and together consider if other action might be necessary. It is important for practitioners in such situations not to feel a sense of personal failure or practitioner incompetence.
Remember: all practitioners experience such rebuffs at some point during their working life. There are some families who are resistant despite anyone's efforts.
What Should I Not Do?
Practitioners 'coping' strategies that may merely obstruct engagement with any other family can be pitfalls when working with hostile families. As a result, perceived or actual harm to the child may be minimised or underestimated by the practitioner so they may need support to understand the family's behaviour and your own response to it.
Practitioners may unknowingly use the following strategies:
- See each situation as a potential threat and develop a "fight" response, becoming over-challenging, thus increasing the tension between the practitioner and the family. This may protect the practitioner physically and emotionally, or may put them at further risk. It can lead to that practitioner becoming de-sensitised to the child's pain and to violence within the home;
- Collude with parents by accommodating and appeasing them in order to avoid provoking a reaction;
- Become hyper-alert to the personal threat so that you become less able to listen accurately to what the adult is saying, distracted from observing important responses of the child or interactions between the child and adults;
- 'Filter out' negative information or minimise the extent and impact of the child's experiences, in order to avoid having to challenge. At its extreme, this can result in practitioners avoiding making difficult visits or avoiding meeting with those adults in their home, losing important information about the home environment;
- Feel helpless/paralysed by the dilemma of deciding whether to 'go in heavy' or 'back off'. This may be either when faced with escalating concerns about a child or when the hostile barrier between the family and outside means that there is only minimal evidence about the child's situation.
It is important:
- That you make every effort to understand why the family may be uncooperative or hostile, and this entails considering all available information. Find out who else is involved, and contact internal and external colleagues or individuals who have had involvement with the family, including the referrer where appropriate;
- To be aware that some families, including those recently arrived from abroad, may be unclear about why they have been asked to attend a meeting, why you want to see them in the office or why you are visiting them at home. They may not be aware of roles that different practitioners and agencies play and may not know that the local authority and partner agencies have a statutory role in safeguarding children, which in some circumstances override the role and rights of parents e.g. child protection;
- That where you think cultural factors are a factor in a family's resistance to having practitioners involved, seek expert help and advice in gaining a better understanding of the culture involved. You could consider asking for advice from local experts, who have links with the culture. In such discussions the confidentiality of the family concerned must be respected;
- If you anticipate difficulties in engaging with a family, you may want to consider the possibility of having contact with the family jointly with another person in whom the family has confidence. Any negotiations about such an arrangement must similarly be underpinned by the need for confidentiality in consultation with the family.
Practitioners need to ensure that clients are treated with respect and dignity at all times. Being practitioner not only involves keeping appointments, and on time, but also ensuring that families are engaged wherever possible and understanding and recognising the impact of cultural differences.
Families may develop a resistance or hostility to involvement if they perceive the practitioner as disrespectful, unreliable or dishonest, or if they believe confidentiality has been breached outside the agreed parameters.
10. Recording Information
It is vital that, as when working with any family, you make a full record of:
- What is said, by whom, when and where;
- What you have said and what actions you have taken;
All paper based records should be signed, dated, and timed with your contact details. Electronic records should automatically record time, date and who completed them, via user identification numbers used for system logins.
Also see: Guidance for Practitioners Completing Chronologies and Genograms.
A Chronology of all concerns relating to a child and their family, dated and sourced, should be recorded in the files of all concerned practitioners. A chronology lists in date order all the major changes and events in a child's life. It can be a useful way of gaining an overview of events in someone's life. It should be used as an analytical tool to help practitioners understand the impact, both immediate and cumulative, that events and changes may have on the child's developmental progress. This includes Non-cooperation of parents. A chronology should include, for example, changes in the family composition, addresses and any moves, educational establishments and any moves, the child's legal status, any injuries, periods in hospital or other medical treatment, and any disclosure of abuse.
11. Recognising Different Types of Hostility and Violence
Despite sensitive approaches by practitioners, some families may respond with hostility and sometimes this can lead to threats of violence and actual violence. It is therefore important to try and understand the reasons for the hostility and the actual level of risk involved. It is critical both for your personal safety and that of the child that risks are accurately assessed and managed.
Threatening behaviour can consist of:
- The deliberate use of silence;
- Using written threats;
- Bombarding practitioners with emails and phone calls;
- Using intimidating or derogatory language – accessing social media, racist/sexualised attitudes and remarks;
- Makes a practitioner feel uncomfortable, using domineering body language and/or undermining the practitioner:
- Using dogs or other animals as a threat;
- Swearing, shouting, throwing things, physical violence;
- Use of recording conversations / videos / photographs via computers or mobile phones;
- Damaging practitioner's property.
Threats can be covert or implied, e.g. discussion of harming someone else. In order to make sense of what is going on in any uncomfortable exchange with a parent, it is important that practitioners are aware of the skills and strategies that may help in difficult and potentially violent situations and that they consult their own agency guidance.
12. Hostility and Violence - Impact on Practitioner
Working with potentially hostile and violent families can place practitioners under a great deal of stress and can have physical, emotional and psychological consequences. It can also limit what you can allow yourself to believe, make you feel responsible for allowing the violence to take place, lead to adaptive behaviour which is unconsciously "hostage-like", and also result in distressing physical or psychological symptoms.
The impact on practitioners may be felt and expressed in different ways, for example:
- Surprise, Embarrassment, Denial, Distress;
- Shock, Fear, Self-doubt, Anger, Guilt, Numbness;
- Loss of self-esteem and of personal and/or practitioner confidence;
- A sense of helplessness;
- Sleep and dream disturbance;
- Hyper vigilance;
- Preoccupation with the event, or related events;
- Repetitive stressful thoughts, images and emotions;
- Post-traumatic stress.
Factors that increase the impact on practitioners include:
- Previous traumatic experiences, both in practitioner and personal life, can be revived and heighten the fears;
- Regularly working in situations where violence and threats are pervasive. Practitioners in these situations can develop an adrenalin-led response, which may over or under play the threat. Practitioners putting up with threats may ignore the needs/feelings of other staff and members of the public;
- When faced with significant fears for their own safety, practitioners may develop a 'hostage-like' response. This is characterised by accommodating, appeasing or identifying with the 'hostage-taker' to keep safe;
- Threats that extend to the practitioner's life outside of work;
- It is often assumed that there is a higher level of risk from men than from women and that male practitioners are less likely to be intimidated. False assumptions decrease the chances of recognition and support. Male practitioners may find it more difficult to admit to being afraid, and colleagues and managers may not recognise their need for emotional support. This may be particularly so if the perpetrator of the violence is a woman or child. In addition, male practitioners may be expected to carry a disproportionate number of threatening service users;
- Lack of appropriate support and a culture of denial or minimising of violent episodes as 'part of the job' can lead to the under-reporting of violent or threatening incidents and to more intense symptoms, as the practitioner feels obliged to deal with it alone;
- Violence and abuse towards practitioners based on their age, race, religion, gender, disability or perceived sexual orientation for example, can strike at the very core of a person's identity and self-image. If the practitioner already feels isolated in their workplace in terms of these factors, the impact may be particularly acute and it may be more difficult to access appropriate support;
- One practitioner taking on the role of mediator for the family, in the belief that they are the only practitioner that the family will accept or trust.
13. Keeping Practitioners Safe
Practitioners have a responsibility to plan for their own safety, just as their agency has the responsibility for trying to ensure their safety. Practitioners should consult with their line manager to draw up plans and strategies to protect their own safety and that of other colleagues. There should be clear procedures on information sharing (both internal and external). Staff and managers need to be aware where further advice can be found.
Prior to contact with a family consider the following questions:
- Why am I doing this visit at the end of the day when it's dark and everyone else has gone home? Risky visits should be undertaken in daylight and in working hours whenever possible;
- Should this visit be made jointly with a colleague or a manager?
- Is my car likely to be targeted / followed?
- Do I have a mobile phone with me or some other means of summoning help (e.g. personal alarm)? Does my manager know my mobile phone number and network, my car registration number and my home address and phone number? Do my family members know how to contact someone from work if I don't come home when expected?
- Could this visit be arranged at a neutral venue?
- Are my colleagues’/line managers aware of where I am going and what time I should be back? Do they know that I may be particularly at risk during this visit?
- Are there clear procedures for what should be done if a practitioner does not return or report back within the agreed time from a home visit?
- Have I taken basic precautions such as being ex-directory at home and having my name removed from the public section of the electoral register?
- Have I accessed personal safety training?
- Is it possible for me to continue to work effectively with this family?
- If threats and violence have become a significant issue for a practitioner, their line manager should consider how the work could safely be progressed; document their decision and the reasons for this.
A few Don'ts:
- Don't take it personally;
- Don't get angry yourself but be firm in your requirements;
- Don't be too accommodating and understanding;
- Don't assume you have to deal with it and then fail to get out;
- Don't think that you don't need strategies or support;
- Don't automatically assume it's your fault and that if you had said or done something differently it wouldn't have happened;
- Don't put personal information about yourself on social networking sites.
- Don't give your personal contact details, such as e-mail address or mobile phone number to families; always give work details.
14. Management Responsibility
Managers have a statutory duty to provide a safe working environment for their employees under the Health and Safety at Work legislation, including:
- Undertaking assessments to identify and manage the risks inherent in all aspects of the work;
- Providing a safe working environment, adequate equipment and resources to enable safe working;
- Providing specific training to equip practitioners with the necessary information and skills to undertake the job;
- Ensuring a culture that allows practitioners to express fears and concerns and in which support is forthcoming without implications of weakness.
Managers need to ensure:
- Practitioners are aware of any home visiting policies employed in their service area and that these policies are implemented;
- Planning time is allowed e.g. to obtain sufficient background information and plan contact; agree safety strategies with manager;
- Strategies and support are in place to deal with situations that arise;
- They are mindful of the skills and expertise of their team. They need to seek effective and supportive ways to enable new practitioners, who may be inexperienced, to identify and develop the necessary skills and expertise to respond to uncooperative families;
- Similarly, more experienced staff may become desensitised and may make assumptions about families and situations;
- Awareness of the impact of incidents on other members of the team;
- Where an incident has occurred, managers need to try to investigate the cause e.g. whether this was racially or culturally motivated;
- Awareness that threats of violence constitute a criminal offence and that the agency must take action on behalf of staff i.e. make a complaint to the police;
- Pro-actively ask about feelings of intimidation or anxiety so that practitioners feel that this is an acceptable feeling.
Supervision and Support
Each agency should have a supervisory system in place that is accessible to the practitioner and reflects practice needs. Supervision discussions should focus on any hostility being experienced by practitioners or anticipated by them in working with families. It should also address the impact on the practitioner and the impact on the work with the family. Managers must encourage a culture of openness, where their workers are aware of the support available within the team and aware of the welfare services available to them within their agency. Managers must ensure that their staff members feel comfortable in asking for this support when they need it. This includes ensuring a culture that accepts no intimidation or bullying from service users or colleagues. A 'buddy' system within teams may be considered as a way of supporting practitioners. Some agencies have confidential staff support systems, which involve sympathetic listeners. Managers should ensure that staff know how to access such support.
Practitioners must feel safe to admit their concerns knowing that these will be taken seriously and acted upon without reflecting negatively on their ability or professionalism.
Discussion in supervision should examine whether the behaviour of the service user is preventing work being effectively carried out. It should focus on the risk factors for the child within a hostile or violent family and on the effects on the child of living in that hostile or aggressive environment. An agreed action plan should be drawn up detailing how any identified risk can be managed or reduced. This should be clearly recorded in the supervision notes. The action plan should be agreed prior to a visit taking place.
The practitioner should prepare for supervision and should bring case records relating to any violence/threats made. They should also be prepared to explore 'uneasy' feelings even where no overt threats have been made. Managers will not know about the concerns unless the practitioner reports them. By the same token, managers should be aware of the high incidence of under reporting of threats of violence and should encourage discussion of this as a potential problem.
Health and Safety should be a regular item on the agenda of team meetings and supervisions. In addition, group supervision or team discussions can be particularly useful to share the problem and debate options and responsibilities. Files and computer records should clearly indicate the risks to practitioners and mechanisms to alert other colleagues to potential risks should be clearly visible on case files.
- British Association of Social Workers: Effective practice to protect children living in ‘highly resistant’ families;
- Summary of risk factors and learning for improved practice around families and disguised compliance;
- Coercive control is now a criminal offence and statutory guidance has been produced for police and criminal justice agencies;
- Findings in the latest National Panel CSPR report.