Engaging Families

1
Engaging Families Working with Resistance

• Patrick Ayre
• Department of Applied Social Studies
• University of Bedfordshire
• (Adapted from Calder, M (forthcoming) The carrot
  or the stick? Towards effective practice with
  involuntary clients,
• Lyme Regis Russell House

2
Why it matters

• In many cases parents were hostile to helping
  agencies and workers were often frightened to
  visit family homes. These circumstances could
  have a paralysing effect on practitioners,
  hampering their ability to reflect, make
  judgments, act clearly, and to follow through
  with referrals, assessments or plans. Apparent or
  disguised cooperation from parents often
  prevented or delayed understanding of the
  severity of harm to the child and cases drifted.
  Where parents made it difficult for professionals
  to see children or engineered the focus away from
  allegations of harm, children went unseen and
  unheard.
• Families tended to be ambivalent or hostile
  towards helping agencies, and staff were often
  fearful of violent and hostile men. Although
  parents tended to avoid agencies, agencies also
  avoided or rebuffed parents by offering a
  succession of workers, closing the case, losing
  files or key information, by re-assessing ,
  referring on, or through initiating and then
  dropping court proceedings.
• Brandon, M, and others (2008) Analysing child
  deaths and serious injury through abuse and
  neglect what can we learn? London Department
  for Children, Schools and Families

3
Engagement

• Engagement is the basic task of a child and
  families worker but can never be taken for
  granted and must always be worked for

4
Context

• Often hard core families so interactions
  characterised by
• guardedness or reluctance to share information
• avoidance and a desire to leave the relationship
• strong negative feelings such as anxiety, anger,
  suspicion, guilt or despair.

5
Context

• We need to accept that
• The best we may be able to achieve is honesty
  rather than positive feelings and a high degree
  of mutuality
• Conflict and disagreement are not something to be
  avoided, but are realities that must be explored
  and understood.

6
Some family centred principles

• Working alongside families rather than
  disempowering them
• Raising the self-esteem of parents rather than
  provoking a defensive or angry response
• Promoting family relationships enabling parents
  to safeguard their children whenever possible
• Focusing on the overall developmental needs of
  children rather than on an overly narrow
  concentration on the alleged incident of abuse.
• (Rose, 1994)

7
What families want

• To be kept fully informed,
• To be treated with courtesy
• To be involved in all stages of the process
• (Cleaver and Freeman, 1995)

8
What families want

• Effort towards developing trust
• Transparency
• Genuine and even-handed
• Direct, yet sensitive
• (Shemmings and Shemmings, 2000)

9
What families want

• Communication which is open, honest, timely and
  informative.
• Time with someone who
• listens,
• gives feedback, information, reassurance and
  advice, and
• is reliable.
• Services which are practical, tailored to
  particular needs and accessible.
• An approach which reinforces rather than
  undermines their parenting capacity.
• (Rose and Aldgate, 2000)

10
Why many interventions fail

• Failure to consider where families are starting
  from (probably different from the professionals)
• Failure to focus on strengths as well as
  weaknesses

11
Stages of engagement

• Pre-contemplation
• Contemplation
• Action
• Maintenance
• Relapse
• (Calder, forthcoming)

12
Pre-contemplation

• Not accepting the need for change or considering
  changing
• Characterised by blaming others, denial or lack
  of awareness (eg depression)
• Need information and feedback to raise awareness
  and acceptance
• May need a legal mandate
• (Calder, forthcoming)

13
4 categories of pre-contemplator

• Reluctant inertia or lack of knowledge
• Rebellious heavy investment in the behaviour
  which needs to change or in making their own
  decisions
• Resigned overwhelmed by problems and has given
  up hope of changing
• Rationalising will explain away the problem and
  why no change is required
• (DiClemente, 1991)

14
Contemplation

• Open to considering the possibility of change but
  may be ambivalent
• Open to receiving, feedback, observations,
  information and even confrontation
• May respond to consciousness raising or to
  emphasising the gains or giving examples of past
  successes.
• (Calder, forthcoming)

15
Six stages of contemplation

• I accept that there is a problem
• I have some responsibility for the problem
• I have some discomfort about the problem and my
  part in it
• I believe that things must change
• I can see that I can be part of the solution
• I can see the first steps towards change.
• (Calder, forthcoming)

16
Action

• Start to work in a structured way on change to
  which they are committed.
• Change is stressful and may fail or feel they
  have failed
• Worker should focus on success and reaffirming
  clients decision to change and look out for
  signs of relapse
• (Calder, forthcoming)

17
Maintenance and relapse

• Change becomes established and internalised, not
  dependent of presence of workers
• Relapse is part of the change process, not in
  conflict with it
• Most people relapse gradually after a slip
  brought on by unusual stresses.
• If not helped they may slide back to
  pre-contemplation, but they can be helped to get
  back on track.
• It can help to emphasise that relapse is common
  and is not the end.
• (Calder, forthcoming)

18
Potential parental responses

• Genuine commitment
• Compliance / approval seeking
• Tokenism
• Dissent / avoidance
• (Horwath and Morrison, 2000)

19
Strategies for enhancing engagement

• Before you start, check your mindset (your own
  biases and assumptions)
• Have realistic expectations
• It is reasonable that involuntary clients resent
  being forced to participate
• Because they are forced to participate,
  hostility, silence and non-compliance are common
  responses that do not reflect my skills as a
  worker
• Due to the barriers created by the practice
  situation, clients may have little opportunity to
  discover if they like me
• Lack of client co-operation is due to the
  practice situation, not to my specific actions
  and activities
• (Ivanoff et al, 1994 )

20
During initial contacts

• Adopt a non-defensive stance
• Be clear, honest and direct and acknowledge the
  involuntary nature of the relationship
• Clarify roles and expectations, including what is
  required of the client
• Explain consequences of non-compliance and the
  advantages of compliance
• (Ivanoff et al, 1994 )

21
Avoid

• Expressions of over-concern
• Moralising
• Criticising the client
• Making false promises
• Displaying impatience

22
Avoid

• Ridiculing the client
• Blaming the client for his/her failures
• Being dogmatic
• Rejecting the clients right to express different
  values and preferences
• (Ivanoff et al, 1994 )

23
Try to

• Invite participation
• Understand how the client sees the problem as
  well as how we see it
• Understand what the client wants, as well as what
  we want
• (Ivanoff et al, 1994 )

24
Identifying resistance, 4 categories

• Hostile resistance anger threats, intimidation,
  shouting
• Passive aggressive compliance covers antagonism
  and anger
• Passive hopeless Tearfulness and despair about
  change
• Challenging Cure me if you can!

25
How might resistance show itself?

• By only being prepared to consider 'safe' or low
  priority areas for discussion.
• By not turning up for appointments
• By being overly co-operative with professionals.
• By being verbally/and or physically aggressive.
• By minimising the issues.
• (Egan, 1994)

26
What might we be doing to make it worse?

• Becoming impatient and hostile
• Doing nothing, hoping the resistance will go away
• Lowering expectations
• Blaming the family member
• Absorbing the family member's anger
• Allowing the family member to control the
  assessment inappropriately

27
What might we be doing to make it worse?

• Becoming unrealistic
• Believing that family members must like and trust
  us before assessment can proceed.
• Ignoring the enforcing role of some aspects of
  child protection work and hence refusing to place
  any demands on family members.
• (Egan, 1994)

28
Productive approaches

• Give practical, emotional support - especially by
  being available, predictable and consistent
• See some resistance and reluctance as normal
• Explore our own resistance to change and by
  examining the quality of our own interventions
  and communication style
• (Egan, 1994)

29
Productive approaches

• Establish a strong and well-articulated
  relationship by
• clarifying all the rules of sharing records,
• inviting people to meetings
• sharing with them how and why you have to make
  decisions
• explaining the complaints procedure
• (Egan, 1994)

30
Productive approaches

• Helping family members to identify incentives for
  moving beyond resistance
• Tapping the potential of other people who are
  respected as partners by the family member
• Understanding that reluctance and resistance may
  be avoidance or a signal that we are not doing
  our job very well
• (Egan, 1994)

31
Confrontation

• In child welfare services, the Childrens Service
  Worker must be a skilled confronter.
  Confrontation is, basically, facing the client
  with the facts in the situation and with the
  probable consequences of behaviours
• (Texas Department of Human Resources)

32
Confrontation

• Client The doctor is telling lies about me. I
  didn't hurt Angie, she fell downstairs. She is
  always having accidents.
• Worker I understand that children have
  accidents. Angie's injuries could not have been
  the result of a fall down stairs. There are two
  partially healed fractures in addition to the new
  head injury. Angie's buttocks and back are
  marked with bruises in the shape of a hand.
• (Texas Department of Human Resources)

33
Confrontation

• Client I know we haven't been to counselling
  in three weeks. Get off my back! My husband
  and I have other things to do.
• Worker Going to counselling regularly is a
  part of your agreement with us to regain
  custody of your children. If the agreement is
  not followed, we can't recommend that the
  children come home.
• (Texas Department of Human Resources)

34
Effective work involves

• Logical discussion
• Focusing
• Prioritising
• Summarising
• Setting realistic limits

35
Effective work involves

• Universalising
• Confronting
• Educating
• Modelling behaviour

36
Effective work involves

• Recognising difference
• Accepting
• Allowing ventilation
• Relating to feelings
• Direct intervention in the environment

37
A scale for assessing motivation

• Shows concern and has realistic confidence.
• Shows concern, but lacks confidence.
• Seems concerned, but impulsive or careless
• Indifferent or apathetic about problems
• Rejection of parental role.

38
Shows concern and has realistic confidence.

• Parent is concerned about childrens welfare
  wants to meet their physical, social, and
  emotional needs to the extent he/she understands
  them.
• Parent is determined to act in best interests of
  children
• Has realistic confidence that he/she can overcome
  problems and is willing to ask for help when
  needed
• Is prepared to make sacrifices for children.

39
Shows concern, but lacks confidence

• Parent is concerned about childrens welfare and
  wants to meet their needs, but lacks confidence
  that problems can be overcome
• May be unwilling for some reason to ask for help
  when needed. Feels unsure of own abilities or is
  embarrassed
• But uses good judgement whenever he/she takes
  some action to solve problems.

40
Seems concerned, but impulsive or careless

• Parent seems concerned about childrens welfare
  and claims he/she wants to meet their needs, but
  has problems with carelessness, mistakes and
  accidents. Professed concern is often not
  translated into effective action.
• May be disorganised, not take enough time, or
  pays insufficient attention may misread
  signals from children may exercise poor
  judgement.
• Does not seem to intentionally violate proper
  parental role shows remorse.

41
Indifferent or apathetic about problems

• Parent is not concerned enough about childrens
  needs to resist temptations, eg competing
  demands on time and money. This leads to one or
  more of the childrens needs not being met.
• Parent does not have the right priorities when
  it comes to child care may take a cavalier or
  indifferent attitude. There may be a lack of
  interest in the children and in their welfare and
  development.
• Parent does not actively reject the parental role.

42
Rejection of parental role

• Parent actively rejects parental role, taking a
  hostile attitude toward child care
  responsibilities.
• Believes that child care is an imposition, and
  may ask to be relieved of that responsibility.
  May take the attitude that it isnt his or her
  job.
• May seek to give up the responsibility for
  children
• (Magura et al,1987)