Working with Families who have Complex Needs Dr Crispin Day Centre for Parent and Child Support, Sou

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Working with Families who have Complex NeedsDr
Crispin DayCentre for Parent and Child Support,
South London Maudsley NHS TrustCAMHS Health
Service Research Unit, Institute of Psychiatry,
Kings College, London

• CPHVA Interest Group for Parenting and Family
  Support
• Friday 27th April, 2007

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Families with complex needs Policy, practice
and evidence priority

• Families
• Significant levels of multi-faceted problems, few
  protective factors
• Child, parents, family, social community
• Severity and number of needs
• Policy
• Personal, family, social and economic costs
• Progressive universalism
• Better and earlier recognition and targeted
  support
• Practice
• High levels of need
• Lower service uptake, increased likelihood of
  drop-out poorer immediate long-term outcomes
• Early, intensive interventions eg.
• Preventive interventions eg NPP
• Group based parenting
• Family Partnership/Parent Adviser

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Family Partnership Model
Partnership
Helper Skills
Helper Qualities
Helping Process
Outcomes
Parent Characteristics
Construction Processes
Service Community Context
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The Helping Process

RELATIONSHIP BUILDING
EXPLORATION UNDERSTANDING
GOAL SETTING STRATEGY
PLANNING IMPLEMENTATION
REVIEW
END
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Family Partnership Approach

• Clear and explicit evidence-based model of the
  process of helping
• Effectively helps families
• Widespread applications
• Popular and effective training programme,
  disseminated within UK, Europe and Australasia
• Vulnerable to universal difficulties

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Families with complex needs About parents,
practitioners helping

• Kirkpatrick et al (2007)
• Barlow et al (2005)
• Day et al (2006)
• Jack et al (2005)

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Families with complex needs Constructions of help

• They just came and told me stuff, but I didnt
  really take it in I just didnt think about it
  that much, I didnt really listen to what they
  told me because I wasnt interested in it
• I was just so worn out, so stressed out sort of
  like, with (3 yr old son), em, I think it was
  more me, than about not having enough
  information
• I thought it was going to be a weekly visit of
  somebody asking me a load of questions, not
  actually giving me support
• I wasnt sure what support meant, because all
  I really needed was a hand, physically, with
  stuff. (They) said it would be someone talking
  to you I needed that like a hole in the head.
• (They) just check that you are keeping your
  kids properly fed. Not to talk to or none of
  that. I was proved wrong. She is there to talk
  to you.
• My life was so hectic that I couldnt commit,
  ..it was a weekly visit and I couldnt commit.

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Families with complex needs Constructions of help

• Perception of needs and priorities
• Perception of change as either possible or
  desirable
• Perception of type of help on offer
• Parents feel too burdened to take on the burden
  of being helped

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Families with complex needs Parents feel
vulnerable

• Worry about how they and their difficulties will
  be seen
• Fear of surveillance, negative judgements and
  their consequences
• Reluctant to be open about dissatisfaction
• play along so that they leave me alone
• Trying to measure up
• Cleaning the house, making their babies/children
  presentable
• Being careful about what is told
• Protecting self and inhibiting relationship
  building
• Having a spouse or family member present,
• Distractions to reduce closeness eg TV on
• Tests of trust eg secondary sources to verify HV,
  testing confidentiality of HV

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Families with complex needs Constructions of the
practitioner

• I always want to say and do the right things in
  front of (her) because Im not sure what will
  happen if I dont
• I didnt get help because I was scared I
  delayed seeking help because I didnt want to be
  judged ..
• (They) come into your house and they say how
  are you?. Within half an hour they will have
  left your house and you dont know when youll
  see them again.
• People shouldnt go around asking people how
  they are to say there, there dear, Im sorry you
  feel upset.. And they go back on with their
  smart life and their nice car and their nice
  children and their nice home.
• You can tell they are there because they enjoy
  what they are doing.. And (those) who are there
  just as a job.. There is a difference those who
  are in it just as a job dont understand it
  depends on the person itself..
• You really do feel like they intimidate cos
  youre a Mum, youre a parent and youre sitting
  in doors and theyre outdoors. They try and
  like, just pushing it down youre throat till
  like it makes you feel like more of a bad
  parent.
• I dont want (them) to get in my face about my
  daughter. Dont tell me to do things that I am
  already doing! Instead, start by asking questions
  to find out what I am doing and why I am doing it.

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Families with complex needs Constructions of the
practitioner

• Judgemental and stigmatising
• Intimidating and threatening
• Lacking authenticity and commitment
• Unable to understand
• Unpredictable
• Untrustworthy
• Ignore parents priorities and needs
• Distant, bureaucratic and administrative

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Family Partnership Model
Partnership
Helper Skills
Helper Qualities
Helping Process
Outcomes
Parent Characteristics
Construction Processes
Service Community Context
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Services reaching outImproving access and
take-up

• Local services embedded in universal child
  provision
• Actively joined up under one roof
• Flexible, drop-in, child/family friendly and home
  visiting
• Stable, consistent and proactive service approach
• Knowledgeable about other services, with personal
  links and experience

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Developing relationships Practitioner qualities
and skills

• I ..expected someone .quite stern and
  strict...(she was) very much a really friendly,
  jolly person
• If theyre to be effective in helping you as a
  parent, then they need to know what you as a
  parent go through
• She talks to you like a human being, she doesnt
  treat you like you dont know anything
• She always made me feel that what I was doing
  was right and they were my viewsShe always
  made me feel in control
• She didnt ever opinionateI didnt feel as if
  she would say.you shouldnt be doing this , you
  should be doing that.
• She was interested in not just (my baby) but me,
  and I found I was able to open up to her
• I feel now , no matter what my problem was that
  she wouldnt judge me.. She knows me, she knows
  me really well. I trust her, I trust her
• They are not just listening to what you say,
  they are hearing what youre saying as well as
  listening although they sound very much the same
  . They are not.

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Relationship building, exploration and mutual
understanding

• I think the most important thing is that you
  work together. Not them coming in and saying
  This is what we do, or the parent saying This
  is what I want you to do
• You dont know them and they want you to tell
  them whats going on in your life and you dont
  really know them and youre not that much
  confident they should get to know you first and
  you get to know them and then they can ask
• Understanding is like listening to people and
  like knowing what their situation is like if
  you cant understand someone or they cant
  understand you they cant help you cos they
  dont know what youre talking about
• You dont know them and they want you to tell
  them whats going on in your life and you dont
  really know them and youre not that much
  confident they should get to know you first and
  you get to know them and then they can ask
• Well wait a little while then askCos Id feel
  more confident and less embarrassed

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Relationship building, exploration and mutual
understanding Earning trust

• Takes time, effort and emotional energy
• The offer of help needs to be meaningful and
  make sense to individual parents
• Practical and personal help
• Being reliable, consistent and confidential in
  word and deed

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Relationship building, exploration and mutual
understanding A connected relationship

• Qualities
• Being involved rather than an observer
• Showing respect interest
• Being open (about own life)
• Skills
• Humour, thoughtfulness and empathic responding
• Sensitivity to language and non-verbal behaviour
• Manage negative reactions to what parents say and
  do
• Mutual understanding
• Seek to understand parents vulnerability how
  wider concerns affect child/parent needs
• Showing genuine understanding for parents

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Partnership working No simple start or end

• Difficult to achieve synchrony reciprocity
• Requires pacing - giving and receiving rather
  than knowing and telling
• Parents may automatically feel that you do not
  listen, do not trust you and feel alienated
• Shared commitment between services, practitioners
  and parents
• Enable parents to manage the intensity of the
  relationship
• Flexible approach, frequency, duration of
  contact, negotiated and renegotiated
• Avoid shift in models to one of risk, judgement
  and expertise

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Developing relationships with complex families
Three reflective questions

• HOW DO I THINK I COME ACROSS TO THIS PARENT?
• - Showing the parent respect - Seeing the issues
  through the parents eyes
• - Being honest and trustworthy - Showing warmth
  and energy
• - Knowing my limitations - Being strong and
  dependable
• WHAT SORT OF RELATIONSHIP DO WE HAVE?
• - We work closely together - We have agreed
  aims and process
• - We share decision making power - We have
  sorted out things about which we disagree
• - We trust and respect each other - We are open
  and honest
• - We understand our complementary - We are
  clear and direct with each other
• expertise and role
• WHERE ARE WE IN THE HELPING PROCESS?
• - Relationship building - Strategy planning
• - Exploration - Implementation
• - Mutual Understanding - Review
• - Goal setting

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Family Partnership Handbook

• Challenging to build partnership relationships
  and maintain focus of helping
• Handbook is to help practitioners to
• Use FP approach in casework
• Reflect on the process progress
• Use in supervision and case discussion
• Handbook contains
• Details of the Family Partnership Approach
• Session plans
• Family Partnership Session sheet
• Reflective Practice sheets

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Working with families who have complex needs
Critical factors

• Connected parent-practitioner partnerships
• Local, flexible reliable services
• Organisations supporting practitioners
• Supervision and casework support
• Recognition, permission and resources
• Open, reflective learning culture

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Further Information
www.cpcs.org.uk Centre for Parent and Child
Support South London Maudsley NHS Trust Guys
Hospital Snowsfields London SE1 3SS Tel 44 (0)
203 228 9751