Intervening in complex families to protect children at risk

The Centre for Excellence and Outcomes highlights best practice in safeguarding children in complex families. This briefing is based on research evidence mainly from the UK and the US on effective interventions to identify and support children in families where they are at risk of or are suffering significant harm.

Identifying complex child protection cases

Research points to three overlapping family groups requiring different approaches to identification, assessment, support, protection and therapy:

● Families whose circumstances are especially complex

● Families who are hard to identify or engage

● Families who are known to services but hard to engage.

There is broad agreement about the characteristics of ‘hard to change’ parents who are at most risk of abusing their children and most resistant to help. These include isolation, own experience of abuse in childhood, being in care, mental illness and drug addiction. Children most at risk of being abused are those with disabilities, premature and/or unresponsive children, those singled out for rejection among their siblings, children who have returned home from care and teenagers who engage in risk-taking or anti-social behaviour.

‘Hard to change’ parents frequently mistrust formal services, as do children and young people who suffer from neglect and maltreatment and who may themselves be ‘hard to help’. Strategies need to be adopted that encourage these parents and children and young people to seek help.

Data from helplines such as Childline and ParentlinePlus suggest that parents and children feel more able to approach services if they feel confident that they can seek advice without losing control of what happens next. This also applies to frontline professionals when making referrals.

The Department of Health Assessment Framework for Children in Need may provide a non-stigmatising route to services, although parents’ and professionals’ perceptions of this route are mixed. Outreach youth workers are well placed to encourage teenagers who have suffered abuse or neglect to seek assistance.

Frontline staff providing universal services need to be aware of the importance of speaking directly with children about issues that may contribute to maltreatment, and should be trained in how to interview children sensitively. Managers of targeted and specialist services should ensure their processes reduce stigma and minimise potential feelings of loss of control in parents and children as this can also be a barrier to referrals.

Engaging families with services

Services need to be dependable, professional and able to provide help that is educative, supportive, timely and practical from the start if they are to win the co-operation of a complex family. A different professional for each parent and child within the family may be necessary so that the parents are helped with their own complex needs without detracting focus from the child’s welfare.

Co-working in a ‘team around the child and family’ can work well, so long as good communication is maintained between all those involved, including the parents and child, to ensure the focus remains on the child.

US intensive family preservation models where single workers with very small case loads are supported by 24-hour access to supervision/consultation also work well. These have been adapted in some UK agencies, including some family intervention projects. Another approach, developed from family therapy, is a co-working model with two workers sharing the lead professional role.

Assessment, decision-making and joint working

A comprehensive assessment must be based on a psycho-social, ‘ecological’ history of all the family members and their relationships, and must be regularly reviewed. Family conferencing is likely to result in a fuller picture of the family’s history and relationship patterns.

A ‘here and now’ observational and strengths-based approach that does not also take into account a thorough analysis of past behaviours risks crude stereotyping and the ‘start again’ approach.

Continuity of social support is essential for complex families who are ‘hard to change’.

Community-based models have been found to lead to a better integration of child protection work between universal and targeted child and family services for families where there are concerns.

Neighbourhood family centres that combine drop-in support and parenting training with targeted outreach can be particularly successful in working with and meeting the needs of families with very complex problems.

High-intensity family preservation services have been found to be more effective in preventing family breakdown if they are preceded and/or followed by targeted lower-intensity or episodic services, or if families can voluntarily re-enter the service if they need to. This avoids the alienation caused by repeated case closure and re-referral.

The multi-dimensional treatment foster care services (MTFC) currently being trialled with children with challenging behaviour and offenders in the UK have been shown to be most effective when the parents or longer-term foster carers are able to become engaged with the programme while the young person is with the specially trained MTFC foster family. Volunteer home visiting schemes and the Community Service Volunteer mentoring support scheme for older children and young carers may also be helpful.

Specific interventions

Manualised ‘model’ programmes show promising evidence of effectiveness where interventions are geared towards strengthening parent-child interactions and reducing child conduct problems. The most robust evidence of effectiveness is in relation to children and teenagers with challenging behaviours, some of which result from parental abuse or neglect.

Multi-systemic therapy (MST) has had positive evaluations in clinical trials with children with challenging behaviour,) but may be less effective when applied in community settings and with children and families with a wider range of problems.

There is no clear message from research that any specific service approaches or methods will be effective with abusing families. Service planners and commissioners should identify broadly the numbers and what kinds of potentially abusing families exist in their area and match this with what is known about best professional practice across the disciplines.

Messages for practitioners

• Providing opportunities for ‘hard to change’ parents and ‘hard to help’ children and young people to seek assistance is important to ensure complex cases are identified at an early stage. Families and children need to feel they can seek advice without losing control of what happens next.

• Frontline staff providing universal services should be aware of the importance of speaking directly with children about potential abuse, and should receive training in asking child-focused questions in a sensitive way.

• Dependable, continuous professional relationships that offer educative, supportive, timely and practical help are essential when working with complex families.

• Multi-disciplinary assessment of the family’s history and past functioning as well as the ‘here and now’ is essential to positive outcomes.

• Continuity of social support is essential for complex families. Neighbourhood family centres combining drop-in support, practical help and parenting training with targeted outreach can be very successful in meeting these families’ needs.

• Manualised ‘model’ programmes appear to be most effective where the focus is on strengthening parent-child interactions and when working with children and teenagers with challenging behaviours.

Case study: Sure Start Early Years and Childcare Service, Lancashire

Concerns about the high numbers of infant deaths and injuries in Lancashire prompted the setting up of a task group to look at how professionals could work better with parents-to-be (especially those deemed to be vulnerable) in the early stages of pregnancy.

The solution was to ask midwives to complete an Early Notification Form with mothers at the booking appointment. This is then passed to the local Children’s Centre, giving them permission to contact the mother before the baby is born and ensure any necessary support is in place.

Early notification of Children’s Centre services is now consistent practice across Lancashire, with clear benefits for families and for professionals. Families are being contacted earlier in the mother’s pregnancy, allowing more opportunity to provide support and additional help where needed. Families have continuity of contact with Children’s Centres from antenatal through to postnatal period, so that a relationship of trust can be established. It also helps to engage more hard-to-reach families with Children’s Centres, so narrowing the inequality gap between outcomes for young children across the region.

Families themselves report feeling better supported and able to make use of the range of other housing, benefits and employment advice available in the Children’s Centres.

This project is one of C4EO’s validated local practice examples.

Further reading

Effective interventions for complex families where there are concerns about or evidence of a child suffering significant harm

www.c4EO.org.uk

Abstracts

Author: TAYLOR Andy; et al.;

Title: Parental alcohol misuse in complex families: the implications for engagement.

Reference: British Journal of Social Work, 38(5), July 2008, pp.843-864.

Abstract: The impact of chronic parental alcohol misuse on both parenting and child welfare is being increasingly recognised, with such problems featuring in a significant proportion of families in which there are identified child-care concerns. There is a growing body of research which suggests that there are often particular difficulties in gaining access to such families. This article explores some of the challenges of reaching children and parents in such circumstances. Based on research that included a wider evaluation of a specialist service for children and families in which alcohol is a problem, a sample of families who ‘dropped out’ of contact are presented and discussed.

Author: SPRATT Trevor;

Title: Identifying families with multiple problems: possible responses from child and family social work to current policy developments.

Reference: British Journal of Social Work, 39(3), April 2009, pp.435-450.

Abstract: In the development of family policy under New Labour there has been a growing tendency to identify groups who are likely to be high in lifetime costs to the state. Investment in such groups is seen as crucial. Identifying one of these groups, ‘families with multiple problems’ raises complex research problems and ethical issues. Research indicates that such families may be identified on the caseloads of child and family social worker and there are claims that key events such as the registration of a child on the child protection register may indicate such multiple problems. This offers opportunities for child and family social work to embrace less incident-based ways of working in favour of longer term provision of services to address longer term risks.

Author: DEVANEY John;

Title: Chronic child abuse and domestic violence: children and families with long-term and complex needs.

Reference: Child and Family Social Work, 13(4), November 2008, pp.443-453.

Abstract: This paper reports the findings from a study conducted on children in the child protection system with long-term and complex needs as a result of experiencing domestic violence. The research identifies the characteristics of the children and their families and tracks their careers through the child protection system in Northern Ireland. The paper argues that government policy and professional practice should primarily be concerned with assessing the risk that men present, rather than the risk that children are at. By reframing professional interventions, men are more likely to be challenged to accept responsibility for their behaviour and the consequences for their families.

This article is published in the 4 March issue of Community Care magazine under the heading Engaging families where children may be sufferering