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Background To work with Parents / Family Intervention

Principles and values of family intervention8 1.All work with families should reflect the rights of the child set out in the UN Convention on the Rights of the Child (1989) ratified by the UK in December 1991. 2.Family intervention utilises a persistent, supportive and respectful approach in working with families which necessitates small caseloads, creative approaches, and a clear strategy for using incentives and sanctions to bring about positive change. The approach is based around a process of strength based whole family assessment. 3.Key workers need to work respectfully and in partnership with families at all times, encouraging self-efficacy and autonomy. 4.Work with families should value and build on their existing strengths knowledge and experience. 5.Those in a parenting role are acknowledged as having unique knowledge and information about their children and are the primary influence on their child’s development 6.Children are the responsibility of, and make a positive contribution to, the wider society as well as their families. 7.Family intervention should place the interests of children and young people at the heart of the work. Key workers should be committed to working with parents and families so that children and young people have the chance to be healthy, stay safe, enjoy and achieve, make a positive contribution, and experience economic well-being. 8.Family intervention should aim to offer a range of appropriate support according to both child and parent level of need, utilising whole family assessment. 9.Family intervention utilises effective working partnerships with agencies and individuals in providing support to parents and families. Integrated working and the sharing of approaches across services is a central element of the key worker role. 10.Family intervention key workers should be committed to engaging children, parents and families fully in identifying goals, assessing options, making decisions and reviewing outcomes. They should support child and family involvement in the development and evaluation of services. 11.Respect for difference and the promotion of equality are of fundamental importance to work with families. 12.Discriminatory behaviour of individuals, families, groups and agencies must be challenged. 13.Those working with families should have specific training, qualifications, support and expertise appropriate to the work they are undertaking.

14.Good practice requires reflection, regular and appropriate supervision and support as well as a continuing search for improvement. 15.Family intervention should use evidence based approaches where possible to encourage and achieve good outcomes. 16.Family intervention requires innovation and creativity to address need. Qualities of effective key workers The most effective key workers have a strong sense of self; they are sufficiently grounded to be able to work in an environment of chaos without losing focus. Key workers are: Able to identify when they are at risk and/or when children and vulnerable adults are at risk in the home or the community. Able to use the training that they receive and the support of their managers, colleagues and agency structures, to keep themselves safe. Able to use their relationships and partnerships with other agencies to secure safety for vulnerable family members. Clear communicators who are able to manage emotions and uncertainty without losing focus. Able to work intensively with a family over a long period of time developing close relationships and offering hands on support and without creating family dependency. The role of a key worker is to: Act as the first point of contact for the family, planning that contact flexibly to meet the family needs. Build a relationship with each family member based on trust and respect, modelling effective communication and persistent support. Galvanise the multi-agency team around the family to participate in putting together a plan with the family, clearly outlining the sanctions and rewards that are associated with each goal. Work with the family to support and challenge them towards reaching the planned goals. Advocate for the family with other agencies Regularly review progress and address barriers to progress in partnership with the multi-agency team. Support the family to use universal services effectively, gradually reducing the intensity of involvement as the family functioning strengthens. Plan an exit with the family, ensuring ongoing support from relevant services (as necessary) building in post intervention contact.

The family intervention approach Eight critical features of the family intervention approach have been identified by the National Centre for Social Research 20089 1. Recruitment and retention of high quality staff: Key worker teams need to include appropriately qualified staff with a range of experience and backgrounds. Together they should have the skills and knowledge that allows them to work effectively with families and agencies. 2. Key worker model: This is vital for ensuring engagement and trust and enables the family to feel responsible to the worker. 3. Small case loads: Key workers generally only have about five families to work with at one time. This helps in building trust and rapport. They are more likely to be available when families need them and are more likely to have the time to uncover deeply rooted issues, supervise and coach individuals in the family and be able to take a persistent and tenacious approach to work with families and other agencies. 4. A whole family approach: This approach enables the key worker to get to root of the difficulties. It is necessary to change the mind set and lifestyle of the families and work to prevent regressive influence. 5. Stay involved as long as necessary: The family intervention approach is able to take a long term approach. The research evidence is that is it not necessarily the amount of time spent with a family each week, but the length of time over which the work is sustained10. Working with families over a long period of time is essential for deeply entrenched issues. It takes time to unlearn attitudes and behaviours, learn new ones, and embed them into daily life. 9 White, C., Warrener, M., & La Valle I., (2008) Family Intervention Projects: An Evaluation of their Design, Set-up and Early Outcomes, Research Report DCSF-RW047, National Centre for Social Research. 10 Dixon, J., Schneider, V., Lloyd, C., Reeves, A., White, C., Tomaszewski, W., Green, R., and Ireland, E., (2010) Monitoring and evaluation of family interventions (information on families supported to March 2010), Research Report DFE-RR044 DfE publications, p54 6. The use of sanctions with support: Sanctions and consequences are key motivators to encourage families to agree to work with the family intervention team. They also help families realise the need for change. 7. Scope to use resources creatively: The family intervention approach recognises that it may be necessary to buy in services and goods such as; beds for children, skips to take away rubbish, cleaning equipment and specially organised rubbish collection, parenting support and therapeutic support. These will enable positive life style change, reward and motivate engagement and meet some of the complex and multiple needs which families struggle with. Key workers work in a flexible and holistic way, using a common sense approach; if a child doesn’t have shoes to go to school, no amount of parenting coaching will reduce the time a parent keeps the child away from school.

8. Effective multi-agency relationships: These are vital to ensure that families get the services and interventions needed. They ensure that a consistent message is given and reduces the opportunity for families to play agencies off against each other. Multi-agency input enables key workers to identify the often shrouded causes of the family’s issues by drawing upon a wide range of insight and experience of the family. Family intervention uses a Team Around the Family (TAF) approach, where professionals and families meet to set targets/goals, identify additional support, and monitor and review progress, though it is sometimes not overtly referred to as the TAF approach. The TAF builds on the Team Around the Child (TAC) approach used in the Common Assessment Framework (CAF).11 To be most effective the TAF is multi-disciplinary in nature, drawing on support from a range of professionals. The seven key stages of the family intervention approach The broad family intervention approach can also be summarised in seven key stages, (sometimes known as the referral to closure model) though there may be variations on this and some stages are likely to be repeated more than once. 1. Referral Examples of referral forms are included as appendices 1 and 2 Families who are referred are frequently at risk of statutory intervention, but may fall below existing service thresholds. Many families also have a history of non-engagement with services and a key criteria for referral is that existing support mechanisms have failed to result in an improvement in outcomes. Research (201012) indicates that referral procedures need to be flexible. This can enable families who fall below existing thresholds to be worked with as well as those where existing provision has failed to result in improved outcomes. Senior gatekeepers (eg managers) decide the suitability of families for support and decisions are often made at weekly allocation meetings. The referring agency has an initial conversation or attends the meeting with the family intervention team to discuss the referral. Sometimes allocation meetings have multi-disciplinary membership so that other services can help evaluate whether the referral is the best way forward for a family. A number of authorities also use existing specialist assessment panels as a source of referrals including: Multi-Agency Risk Assessment Conference (MARAC) supporting high risk victims of domestic violence. Multi-agency panels for children, young people and families in receipt of multiple targeted and/or specialist services, where existing support has been unable to effect change. Panels for children and young people at risk of being looked after. Anti-Social Behaviour Action Group (ASBAG).

Different projects focus on working with families from different target groups. The referral routes for family intervention are therefore likely to differ and reflect local circumstances and priorities. Referral criteria will also differ and could include: Families at risk of statutory intervention and the application of sanctions and enforcement actions. This includes children on the edge of care (many family intervention services are now working with this target group as it helps address local priorities). Families with a history of non-engagement with services. Families where outcomes have failed to improve through existing support mechanisms. Families involved in high risk (dangerous, abusive or reckless) anti-social behaviour (ASB) and/or at risk of losing their home due to their ASB. Youth offending, either as a consequence of a history of youth offending or where an older person/prolific young offender may impact upon younger family members. Persistent reports of ASB from neighbours, ASB unit, housing providers, police and other agencies. Combinations of worklessness, domestic violence, poor adult mental health, substance misuse, etc. Compromised parenting eg substance misuse, domestic violence, prolonged absence, neglect, parental offending activity, combination of factors. High levels of truancy or exclusion from school. There are also likely to be trigger points to the referral; events or circumstances which raise the level of urgency for the family to need to change or elevates their profile to agencies in the locality. These can include: Threat of eviction. Persistent reports of ASB. Repeat referrals to MARAC. Reported combinations of a range of identified risk factors such as criminal activity within the family, poor attendance at school by children and substance misuse. If it is agreed that the referral is appropriate for the family intervention team, the referring agent will make an appointment to visit the family with the family intervention senior key worker. A key worker might be allocated to the family at this stage. In this case the key worker completes an initial risk assessment, focusing on risks that the family and key worker may face. This provides the key worker and the family intervention service with a clear summary of factors to be monitored in the developing relationship. An example of an initial risk assessment form is included as appendix 3 In some situations a referring agency might be required to provide initial information and a risk assessment on the family. This is discussed in a multi-agency context before the referral is agreed.

Multi-agency referral meeting A multi-agency referral meeting takes place within two weeks of allocation to gather further information about the family. This involves the family, the key worker and all other agencies involved. It is chaired by the senior key worker or manager. Details of professionals involved are held on the family file and recorded in all formal meeting minutes. The background to the case and reasons for referral are discussed, and the meeting seeks agreement from the family to undertake an assessment.

Families at Risk Risk is part of the language that is regularly used when discussing families with multiple and complex needs. They are sometimes referred to as families at risk. Families are identified by a risk assessment which looks at the extent to which they are presenting risk factors that are known to be linked to poor outcomes. The 2009 Families at Risk Review39 estimated that around 140,000 of the 13.8 million families in England experienced at least five of the risk factors that are known to be linked to poor outcomes. The risk factors included in this analysis were: No parent in the family in work. Family living in poor quality or overcrowded housing. No parent with any qualifications. Mother with mental health issues. At least one parent has a long standing limiting illness, disability or infirmity. Family with low income (below 60 per cent median). Family unable to afford a number of food and clothing items. There are many other risk factors including involvement in criminal or anti-social behaviour by one or more family members; learning difficulties; drug and alcohol dependence; a history of or current domestic violence and long term unemployment.40