The heart of the family

An assistant director of children’s services at
children’s charity NCH, Pete Andrews has more than 30 years’
experience working in a variety of child care settings, including
as a child protection co-ordinator for a large local authority. He
has been an NCH manager for more than 10 years.  

Families First is an intensive, in-home crisis intervention and
family education programme. Its basic goals are specific and
limited: to prevent the need for out-of-home placement and to teach
families the basic skills necessary to remain together.

Originating in Washington as “Homebuilders” in 1974, the model has
spread from the US to Canada, Australia and Europe. The first UK
project was set up by NCH in Hull and the second in Tower Hamlets,
London. NCHhas recently evaluated the Tower Hamlets scheme and the
results are encouraging: 88 per cent of the young people referred
remained in their homes at the end of the intervention. In other
Families First projects, 85 per cent of children referred are still
at home one year after intervention ceased.

These are impressive results given that the service works only with
families at the point of crisis, and where a placement is being
sought for a child or young person out of the family home.

So what does the model involve?

Families First works with families in crisis for a maximum of six
weeks. A case worker visits the family within 24 hours of referral,
begins work immediately and is available to the family 24 hours a
day, seven days a week.

Within the first 72 hours, each family member agrees goals with the
case worker. Each visit is focused, undertaking a piece of work
around a specific goal. Sessions with the family are as short or as
long as necessary and the worker spends as much time with the
family as is necessary to defuse the crisis and to let the family
develop achievable goals.

The intensity of the programme does not mean that families can
abuse the availability of their case worker. Pagers are used,
rather than mobile phones, and families value the respect of
professionals and their belief that they have strengths and skills.
Each worker carries a caseload of no more than two families, works
a 37-hour week and has regular days off.

Because Families First believes that crisis is an opportunity for
change, the model is less likely to be successful where families
are not in crisis. But the crisis means that the programme is
intense both for the family and the case worker.

Although families may not initially share the same concerns as
professionals about their functioning, in every case following
intervention families have outlined goals that also mirror
professional concerns. Families unable to set goals tend to drop
out of the programme.

The model constantly reinforces respect for the family, parental
strengths and family skills. Intervention is solutions-focused and
works on identifying and building on family strengths. Work
undertaken is in the here and now, with limited emphasis on
psychodynamics. The aim is to work with the family to build on
strengths and develop skills using existing family patterns of
behaviour, not to unpick the past.

For many of the individuals within families referred there are
significant issues, which may require longer-term therapeutic
input. These individuals are referred on, or therapy can work
alongside the Families First programme.

Families First workers need to believe that people are doing the
best they can and that everyone has the ability to change. They
undergo an intensive training programme which challenges existing
attitudes or prejudices towards families and equips them with a set
of techniques to help families set and achieve goals. They are also
trained to alter mindsets as well as teach skills.

The emphasis on changing mindsets is a major bonus for partners
such as social workers. By operating alongside workers with
solutions-focused, family-strengths approach, key workers in the
statutory sector are likely to develop more positive views of
family functioning.

Early research undertaken in the Hull project showed that families
could remember the name of their Families First worker a year after
the intervention even when they could not recall their current
social worker’s name. It also indicated that many of the Families
First-taught skills and techniques were still being practised a
year later.

Families First produces positive benefits for some of the most
difficult-to-reach families, but it is not a magic bullet. Many
families who successfully complete the programme may need some form
of continuing support, but one notable area of success has been to
engage families who have rejected professional help in the
past.

Families First offers a clear, outcome-focused, off-the-shelf
package that works best as a partnership between a voluntary agency
and the statutory sector.

Case study

Denise Davies* had reached the end of her tether. Chris, her
14-year-old daughter, had been caught shoplifting and was truanting
from school. After Chris went missing for four days, Denise visited
her local assessment and advice team and begged for help. She was
referred to Families First and, after an initial interview, began a
six-week crisis intervention programme. 

“I had lost all the confidence I ever had in parenting,” she
says. “I blamed myself for Chris’s behaviour. Tim [the Families
First practitioner] was able to re-instate that confidence by
working with us as a family and getting us all to think about what
we were doing from a different perspective.”  

At the initial Families First meeting Chris recognised changes
were needed as she was not happy with her relationship with her
mother. A mutually agreed contract was drawn up for them to work on
topics such as setting boundaries, communication and trust-related
issues.  

Denise feels the contract played a major part in the progress
the family has since made. She says: “Because there was an
independent person at our meetings we were able to talk through
issues that had become a problem. I wasn’t prepared to leave Chris
in the house on her own because I just didn’t trust her. Now I have
learned, through agreeing to do this for half-hour periods, that I
can begin to trust her again. 

 “The fact that Tim was always available made a big difference.
I knew that if I was facing a particular problem I could speak to
him and he would give me really good advice. There were times when
I just don’t know what I would have done without that support.”  *
All names have been changed   

Abstract 

Families First is an intensive crisis-intervention model
imported originally from the US which aims to keep families
together. This article discusses the model, how it works and why,
and looks at the results of an appraisal of the second UK project
in Tower Hamlets which recorded an 88 per cent success rate in its
first year.      

References

• To obtain a copy of the Tower Hamlets Families First evaluation
  report, e-mail lnart@mail.nch.org.uk 
• Raymond S Kirk and Diane P Griffith, “Intensive Family
  Preservation Services: Demonstrating Placement Prevention Using
  Event History Analysis”, in Social Work Research, Vol 28,
  Number 1, March 2004 (Includes an extensive bibliography of
  previous studies)    

Further information

For more information about NCH, e-mail www.nch.org.uk    

Contact details

Contact the author by phoning 01482 799526